Chapman Rose

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Rosie Dang and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 12:30PM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 6-bedroom, 4-bathroom, two-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 5 residents present at the facility in addition to AD. Resident Bedrooms: the 5 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 2 staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 112 and 119 degrees F in the 3 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the kitchen and garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 10:30AM, LPA reviewed 5 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 5 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on observation, four resident rooms had cameras placed there by the licensee; based on documents, the licensee was unable to locate their infection control plan at the facility; based on documents, the licensee does not have doctor's orders for R3's melatonin and R4's ashwagandha which are being administered; based on documents, the physician's reports for R2 and R3 are on the old form and do not include required information, including behavioral expressions; based on documents, R1 and R5 do not have appraisals, and R2 and R4 have appraisals that are more than one year old; and based on documents, the licensee was unable to locate documentation of emergency disaster drills conducted in 2026 at the facility. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, May 28, 2026

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Rosie Dang and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 2:00PM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 6-bedroom, 4-bathroom, two-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 1 staff and 4 residents present at the facility in addition to AD. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 105 and 107 degrees F in the 3 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the kitchen. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 3:00PM, LPA reviewed 4 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 4 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on documents and admission, Staff #1 (S1), who is a roommate of AD but not a staff, has been living at the facility for a long time but has not been background cleared; based on admission, the licensee has not been conducting quarterly emergency disaster drills; based on admission, the facility has two floors but does not have an evacuation chair; based on observation, the facility's fire extinguisher has not been serviced in more than a year; and based on documents and admission, the licensee did not ensure Resident #1 (R1) had a physician's report prior to admission. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421BG. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, May 21, 2025

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Rosie Dang, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 09/25/2023. This is an initial application with no residents in care. This is the second pre-licensing inspection. Please see LIC809 dated 03/06/2024. During the initial inspection, LPA and AP observed the following: the water temperature in the east resident bathroom tested at 130 F degrees. The resident bedrooms did not have lamps. The facility has a second floor which is not reflected on the floor plan. AP stated they will correct these issues and notify LPA once they have been corrected. Regarding the fire clearance, AP stated they will request a new fire clearance clearing the “Reception/Staff Office” room as either a resident bedroom or staff bedroom and clearing the second floor for 2 staff bedrooms, a bathroom, and a small common area. AP stated that the new facility sketch will reflect these changes and include the second floor. Since the initial pre-licensing inspection, AP corrected the water temperature, obtained and installed lamps in the resident bedrooms, and obtained a new fire clearance which includes the second floor and also changes the designations of certain rooms. During today’s inspection, LPA toured the facility with AP, observed the water temperature tested between 112.5 degrees F and 117 degrees in the three resident bathrooms, observed lamps in all resident bedrooms, and observed the new fire clearance includes the second floor and that the applicant is following the new fire clearance. LPA confirmed that the issues noted during the initial pre-licensing inspection have been addressed. LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. Component III was completed during the initial pre-licensing inspection. An exit interview was conducted and a copy of this report was discussed with and provided to AP.the state’s words, verbatim · CDSS document, May 6, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Rosie Dang, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 09/25/2023. This is an initial application with no residents in care. During the inspection, LPA and AP observed the following: Structure: this is a two-story home. Facility is a 6-bedroom, 3-bathroom, 2 story house with an attached garage that is being used for storage. There is a back yard with a patio cover for the residents. Facility telephone number is (714) 583-8174. Resident Bedrooms: the 3 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 130 F degrees. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers and Exit Plan: reviewed. Food Service: 7 days nonperishable food supply reviewed and AP stated they will obtain 2 days perishable food supply prior to accepting residents. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: inspected. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet is locked. First-Aid Kit and Activity Supplies: observed and available. Resident & Staff Files: this is an initial inspection and LPA observed storage space for resident and staff files. Fire clearance was approved by Orange County Fire Authority on 12/11/23. Backyard: backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AP during today’s inspection. AP will obtain liability insurance once the application is approved. During the inspection, LPA and AP observed the following: the water temperature in the east resident bathroom tested at 130 F degrees. The resident bedrooms did not have lamps. The facility has a second floor which is not reflected on the floor plan. AP stated they will correct these issues and notify LPA once they have been corrected. Regarding the fire clearance, AP stated they will request a new fire clearance clearing the “Reception/Staff Office” room as either a resident bedroom or staff bedroom and clearing the second floor for 2 staff bedrooms, a bathroom, and a small common area. AP stated that the new facility sketch will reflect these changes and include the second floor. During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed the item(s) listed above must be completed for the facility to meet Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to AP.the state’s words, verbatim · CDSS document, Mar 6, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Dang, Rosie - Administrator and Hung, Nguyen - Applicant Interview Method: Virtual interview (MS Teams) On 01/22/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jan 22, 2024