AA Plus Care Home

Type of visit: Required - 1 Year

On April 1, 2026, at 2:00 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Licensee Kelly Ho arrived at the facility and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) bathrooms, living area, den kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with Caregiver Gener Gutierrez. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were clean. The water temperature measured at 106.7 degrees F. A comfortable temperature of 75 degrees F was maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. The top right drawer next to the refrigerator was broken. When the drawer was opened, the bottom of the drawer was not connected to it. Emergency food, emergency water, and emergency supplies are stored in the garage. The smoke detectors were operable. LPA observed carbon monoxide detector was not operating as intended. The detector would go off without any carbon monoxide issues. A working telephone (714-463-4194) remains available. Last emergency drill was conducted on March 25, 2026. First aid kit is maintained and contains all the necessary elements. LPA Kim conducted an audit of resident files (R1-R4), staff files (S1-S7), and medication and medication administration record. LPA Observed appraisal needs and service plan for R1 dated 1/26/2024, R2 dated 3/12/2024, and R3 dated 1/10/2024. LPA Kim conducted one (1) staff interviews and four (4) resident interviews. LPA interviewed S2 who stated that S1 pre-made medication containers for each resident and time from March 28, 2026, to April 1, 2026. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed carbon monoxide detector not operating as intended and the top shelf in the kitchen drawer next to the refrigerator was broken. LPA interviewed S2 who stated that S1 pre-made medication containers for each resident and time frame from March 28, 2026, to April 1, 2026. LPA observed and took photos of the containers the facility used. LPA observed appraisal needs and service plan dated for R1 dated 1/26/2024, R2 dated 3/12/2024, and R3 dated 1/10/2024. An exit interview was conducted, and a copy of this report, LIC811, LIC809D, and appeal rights were provided to Licensee Kelly Ho.the state’s words, verbatim · CDSS document, Apr 1, 2026

Type of visit: Required - 1 Year

On April 1, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Anna Aquino. Administrator (AD) Shelly Yamashiro and Licensee Kelly Ho arrived at the facility and LPA Kim explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) bathrooms, living area, den kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with CG Aquino. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were clean. The water temperature measured at 134.6 degrees F to 137.4 degrees F. A comfortable temperature of 75 degrees F was maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-463-4194) remains available. Last emergency drill was conducted on April 1, 2025. First aid kit is maintained and contains all the necessary elements. Evidence of Liability insurance was effective from April 24, 2024, to expiration on April 24, 2025. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S6), and medication and medication administration record. LPA Kim conducted two (2) staff interviews and two (2) resident interviews. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed S2-S6 annual 20-hour training for 2025 were not available, LPA Kim observed a partition in the den where there is a bunkbed where staff sleep in, and LPA Kim observed water temperature for bathroom 1 and bathroom 2 measuring from 134.6 degrees Fahrenheit to 137.4 degrees Fahrenheit. Technical violations were cited during this visit. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Kelly Ho.the state’s words, verbatim · CDSS document, Apr 1, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA arrived and was greeted and granted entry by Administrator Shelly Yamshiro and Licensee Kelly Ho. An application to operate a Residential Care Facility for the Elderly (RCFE) for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 10/18/2023. The facility is a one-story home with four client bedrooms, two bathrooms, living room, den, dining room, kitchen, covered patio, backyard and 2-car garage. Client Bedrooms have all the necessary requirements including bed, chair, storage for clothing and ample lighting. LPA observed all windows were screened. All bathrooms have working plumbing and designated hand washing posters. Hot water measured at 115.8 degrees Fahrenheit and 118 degrees Fahrenheit in the bathrooms. LPA observed the fire extinguisher to be fully charged as indicated by the arrow pointing in the green zone. LPA observed a service tag indicating the extinguisher was last serviced in October of 2023. Medication and First-Aid Kit will be locked in a closet in the hallway. Resident & Staff Files will be locked in drawers at at desk in the dining area. The fire clearance was approved by a fire inspector of Orange County Fire Authority on 2/13/2024. LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients and are stored and locked under the kitchen sink and in the garage. A supply of extra linens is stored in a closet in the hallway. Emergency Phone Numbers, Exit Plan, Activity Calendar and Menu are all posted and available for review. LPA observed other necessary postings in the living room. Smoke and Carbon Monoxide detectors are stationed throughout the home and are wired together. Both types of detectors were tested and noted as operational. Operational appliances include a gas stove, oven, two refrigerators, dishwasher, microwave, washing machine and dryer. LPA reviewed and provided Administrator and Licensee with the Component III presentation to offer information and resources regarding maintaining facility compliance. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.the state’s words, verbatim · CDSS document, Apr 3, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.