306006755-1-30-2026-22-AS-KLYN-DQTP93-20260130100628

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006755
Report Date: 01/30/2026
Date Signed: 01/30/2026 10:06:40 AM

Document Has Been Signed on 01/30/2026 10:06 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:	HOPE QUALITY HOMES, INC		FACILITY NUMBER:	306006755
ADMINISTRATOR/ DIRECTOR:	ALIPIO, DIVINA JOY		FACILITY TYPE:	740
ADDRESS:	12501 TUNSTALL ST		TELEPHONE:	(657) 352-8841
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92845
CAPACITY: 4		CENSUS:	DATE:	01/30/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Divina Alipio		TIME VISIT/ INSPECTION COMPLETED:	10:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Administrator/ Licensee Divina Alipio. An initial application to operate a Residential Care Facility for the Elderly was submitted to Community Care Licensing on 10/05/2025 for a capacity of three ambulatory and one non-ambulatory resident. Upon entry, facility appears clean, safe and sanitary. Facility has all required postings including personal rights, theft and loss policy, and the complaint poster. Administrator Divina Alipio has an administrator certificate expiring on 06/19/2026. LPA Lyman along with Administrator Alipio toured the facility at 8:19 AM and observed the following: Structure: Facility is a one story home with four bedrooms, two restrooms, living room, screened patio, dining room and kitchen and a grey exterior. Living Room/ Dining Room: Adequate seating is available in the dining room and living area. Bedrooms Residents: Rooms are single occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample storage space, Exit doors have auditory alarms. Linens & Hygiene Supplies: Facility has ample bedding and towels in supply as well as hygiene supplies. Bathrooms: All resident bathrooms have a working toilet/ wash basin/ grab bars as well as paper towels and soap. Emergency Phone Numbers and Exit Plan: Posted in the entrance of the facility. Food Service: LPA observed the kitchen and serving area. Facility has two day perishables and seven day non-perishables. LPA observed a sample menu. Smoke Detectors: Smoke detectors and carbon monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Appliances: Kitchen and laundry appliances are clean and operational. Toxins/ Sharps: Facility has secured areas for toxins and sharps. CONTINUED ON LIC 9099C DATED 01/30/2026

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Kimberly Lyman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

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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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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HOPE QUALITY HOMES, INC	FACILITY NUMBER: 306006755
	VISIT DATE: 01/30/2026

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Water Temperature: Tested and recorded between 105.2 and 108.6 degrees F. in facility restrooms. Emergency Supplies: LPA observed ample emergency food and water as well as emergency packs for residents. LPA observed the emergency disaster plan which is thorough and complete. Medications, First-Aid Kit & Book: First aid kit observed contained all required items including tweezers, scissors and thermometer as well as a first aid manual. Medications to be stored in a locked cabinet. Facility to use a medication administration record. Resident & Staff File: Records are to be stored in a locked cabinet in the screened in porch. Reading Material, Games, and Equipment: LPA observed a posted activity schedule with activities such as games and outings in the community. Outside areas: LPA observed an outside area with ample shaded seating. Fire Clearance: Approved for three ambulatory and one non-ambulatory resident on 08/21/2025.

Component III conducted during the visit.

Facility is ready to be licensed. Exit interview conducted and a copy of this report was left at the facility.

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Kimberly Lyman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC809 (FAS) - (06/04)

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