Acclaimed Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced required 1-year visit to the facility. LPA met with Kim Ebueng, Licensee and discussed the purpose of the visit. The facility is Residential Care Facility for the Elderly (RCFE). Licensed capacity of 6 with a current census of 4. LPA conducted an overall inspection of the facility, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature 75 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with the required furniture such as beds, mattresses, night stands, storage space, chairs and sufficient lighting. Bathrooms were clean and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The hot water temperature tested between 106 and 113 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents. All the sharps are locked. There was a designated area for resident/staff files. Overall, the facility is clean, in good repair, and operating in a safe condition for resident in care. Food Service: Non-perishable and perishable food supply is sufficient for the number of residents. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (2) resident files for admission agreements, updated physician reports, and needs and services plans. Resident files are maintained and up to date. LPA reviewed (2) resident medications. Medications are labeled and administered as prescribed. Medications are kept locked and inaccessible to residents. LPA reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Facility staff records are up to date. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C was discussed and provided to Kim Ebueng, Licensee.the state’s words, verbatim · CDSS document, Jul 15, 2026

Allegation investigated: Staff does not provide a safe environment for resident.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver the findings on the allegation listed above. LPA met with Licensee Kate Ebueand explained the purpose of today’s visit. The investigation consisted of staff interviews, resident interviews and record review. For the allegation, Staff does not provide a safe environment for resident. During staff interviews, 4 out of the 4 staff stated they provide a safe environment to residents. During resident interviews, 2 out of the 3 residents stated they feel safe at the facility, and 1 out of the 3 resident was unable to answer LPA questions. Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaint are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Licensee Kate Ebueng. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 23, 2025 · control 56-AS-20250918125049

Type of visit: Prelicensing

On 07/2/2025 at 9:30 am Licensing Program Analyst (LPA) Beena Singh conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation. LPA Singh met with Administrator LEA EBUENG. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 09/25/2024 for a total capacity of six (6) two ambulatory (2), two (2) non-ambulatory and two (2) bedridden residents. Fire clearance was granted on 12/06/2024. LPA observed the following: Structure: The facility is a one storey house with four (4) bedrooms, two (2) resident bathrooms, a living room, dining area and kitchen. There was an attached two car garage on the front of the house. Heating /Cooling System: Central heating and air conditioning system installed with a control panel located in the garage of the facility. Bedrooms: Bedrooms will accommodate two (2)ambulatory, two (2) non-ambulatory and two (2) bedridden residents are adequately furnished with bed, closet, appropriate linens and adequate lighting. Night lights were observed in the facility and will be placed in the hallways leading to residents' shared bathrooms. Bathrooms: There are two (2) bathrooms for the residents which have working toilets, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 110 degrees Fahrenheit in the resident’s bathroom. Kitchen: The kitchen has an adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp and hygiene care items were secured in a locked drawer located in the kitchen. There was an adequate room for food storage. LPA observed the stove to be operational. Refrigerator(s)/freezer(s) were in working condition. There was sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry: Laundry room with washer and dryer was upstairs. Laundry detergents and cleaning supplies will be locked in the laundry room, which can be locked from exterior door. Living /Family Room: There was a living/family room with a TV and adequate seating for all residents. Residents Activities, pool table and furniture will be placed in the living area for the residents. Linens and Hygiene: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outdoors: There is sufficient covered seating area the backyard. The gate on the right side is the exit and will be locked due to dementia residents. There is a storage/staff unit in the backyard. All outdoor pathways were free of obstructions. All exit doors have operating delayed egress devices. Emergency Phone Numbers and Exit Plan: Facility sketches were observed posted in the main living room area. There were two(2) fire extinguishers and seven (7) carbon monoxide detectors and seven(7) smoke detectors connected with one unit which are working and in good condition. General items: Client records will be stored in a locked cabinet in the kitchen area. First Aid kit with required components is located in the dining room cabinet. Personnel files and medication will be locked in the cabinet next to the television sitting area. LPA observed a facility phone-951-223-3387 and it was verified to be operational. Emergency water supply and food were observed. The facility has met the requirements according to Title 22 regulations and is ready for licensure. An exit interview was conducted, no deficiencies were cited, Component III was completed during this visit, and a copy of this report was reviewed and provided to the Facility Administrator EBUENG, LEA.the state’s words, verbatim · CDSS document, Jul 3, 2025