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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006429
Report Date: 02/09/2024
Date Signed: 02/09/2024 09:48:12 AM

Document Has Been Signed on 02/09/2024 09:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:T&T SWEET HOMECAREFACILITY NUMBER:
306006429
ADMINISTRATOR:MARY HANFACILITY TYPE:
740
ADDRESS:8445 PHILODENDRON WAYTELEPHONE:
(714) 623-3194
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 0DATE:
02/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Mary HanTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection to follow-up on corrections identified during visit on 2/01/2024. LPA arrived at the facility and was greeted and granted entry by designated Administrator (AD) Mary Han. An application to operate an Residential Care Facility for the Elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by CCL on 9/27/2023.

At 9:00 a.m. LPA toured the facility and observed the following:

  • Water temperature has been adjusted and tested at 120.3 degrees F.
  • See Something, Say Something poster (PUB 475) is regulation size of 20” x 26” and was observed to be posted in the main entryway of the facility.
  • Facility has a shaded seating in the backyard that is equipped for outdoor use.
  • Hand soap supply was observed to be available in residents’ bathroom.
  • Fireplace was observed to be screened.
  • Facility’s policy concerning family visits and other communication with residents was available for review and was observed to be accessible to residents and families.
  • First aid kit was observed to have a thermometer.
  • LPA conducted an inspection of the garage and observed it is being used as facility storage.

Component III: Conducted during this inspection, information provided about how to operate the facility within compliance and reporting requirements. (Cont. LIC809-C)
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: T&T SWEET HOMECARE
FACILITY NUMBER: 306006429
VISIT DATE: 02/09/2024
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The facility is ready to be licensed. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau (CAB) in Sacramento. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC809 (FAS) - (06/04)
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