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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006689
Report Date: 05/19/2025
Date Signed: 05/19/2025 11:26:11 AM

Document Has Been Signed on 05/19/2025 11:26 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NEWLIFE COMFORT CAREFACILITY NUMBER:
306006689
ADMINISTRATOR/
DIRECTOR:
PHUNG, JENNYFACILITY TYPE:
740
ADDRESS:15071 EDEN STREETTELEPHONE:
(951) 707-5799
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 6CENSUS: 0DATE:
05/19/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Jenny PhungTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Administrator (AD) Jenny Phung.

An application to operate a Residential Care Facility for Elderly (RCFE) was received by our agency on January 06, 2025 for a total capacity of six non-ambulatory only. Fire clearance was approved by a fire inspector from the Orange County Fire Authority on February 11, 2025.

The facility is a one-story home with three resident bedrooms that are shared rooms, one staff room, two bathrooms, a living room, a kitchen, a dining area, and an attached two car garage. There is one gate on the right side of the house that is self-latching and unlocked. There is no seating area with shade for residents in the backyard or outside.

LPA did not observe any administrator certificates post on the wall. The Ombudsman and The See Something, Say Something poster (PUB 475) were small and did not meet the department standards. LPA did observe Personal Rights and Facility sketch posted up on the hallway walls. There was no Emergency Disaster Plan posted in the facility. LPA advised administrator that notices and postings needs to be visible to residents and visitors in an area like the front entry way. Fire extinguisher is in the dining room by the kitchen fully charged. Fire alarms and carbon monoxide detectors worked properly and are operational.

Resident bedrooms did not meet the required furnishings. There is a lamp missing in one room. Chairs are not provided for all residents in the facility. LPA observed all beds had linens and blankets. The toxic chemicals, cleaning solutions, and disinfectants have no designated locked secured area for storage. Medications will be stored in a locked cabinet in the hallway. The first aid kits are in the staff room and are incomplete, the kits are missing thermometers. There is no first aid book. Staff and resident records will also be stored and locked in the cabinet in the hallway. LPA observed activities such as board games, puzzles and reading materials provided by the administrator in the staff room. There is a phone for residents to use.

Pre-licensing Inspection continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NEWLIFE COMFORT CARE
FACILITY NUMBER: 306006689
VISIT DATE: 05/19/2025
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There is a laptop for residents to use.

A supply of non-perishable food was observed, and perishable food will be maintained on hand. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. There is no secured locked storage for sharps in the kitchen. The hot water temperatures in the bathrooms measured between 120.7 Fahrenheit degrees and 122.1 Fahrenheit degrees. LPA explained to the administrator that water temperature needs to be between 105 to 120 Fahrenheit degrees. There is no emergency food and water, and additional emergency disaster supplies observed at the facility.

Licensee will need to address the following issues and need to be corrected to be licensed:

· Walls of the facility need to be clean, there is dirt, dust, cobwebs

· Bathroom and sinks need to be cleaned

· Nonslip bathmats in each shower

· Grab bar is missing in shower of Bathroom #1

· Air vents need to be cleaned of dirt and cobwebs

· Crack in ceiling wall needs to be repaired

· Crack on Bedroom #2 Door needs to be fixed

· Chairs for each resident in the rooms, a total of 6 chairs

· Lamp is missing for Bedroom #3

· Needs to be door for Bedroom #3 for resident privacy

· Shaded patio furniture and umbrella for residents outside

· Administrator certificate needs to be posted

· Pub 475 “See Something Say Something” Poster needs to be 20x26

· Ombudsman Poster needs to be 20X26

Pre-licensing Inspection continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NEWLIFE COMFORT CARE
FACILITY NUMBER: 306006689
VISIT DATE: 05/19/2025
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· Notices and personal rights to be posted in front entry way area

· First Aid kit is missing: thermometer

· First Aid booklet by American Red Cross or American Medical Association

· Window and door alarms or alerts

· Emergency food, water

· Emergency disaster supplies

· Locked cabinet for knives/sharps in the kitchen

· Locked cabinet for chemicals/toxins in the kitchen or laundry area

· Need to see samples of Admission Agreement for files

The facility is not ready to be licensed. Licensee will contact the LPA to schedule a second Pre-licensing visit when corrections are completed. An exit interview was conducted, and a copy of this report was provided to Licensee.

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
LIC809 (FAS) - (06/04)
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