Early Bird Care Home 3

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javier Prieto visited the facility unannounced to complete a comprehensive annual inspection. LPA Prieto met with Administrator Chantharaseth and explained the purpose of the visit. Today’s inspection included a facility tour, record reviews, and interviews with staff. Residents in care were unable to participate in the interview process. Facility was a single story house with four (4) bedrooms, two (2) bathrooms, living room, dining area, office space, and kitchen area. Licensed capacity is six (6), and the facility is at a census of 5 during today's inspection. Physical Plant: There are no obstructions to indoor and outdoor passageways. The facility temperature is 76 degrees Fahrenheit. LPA inspected resident bedrooms; each room included required furniture such as mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were functional. LPA Prieto observed adequate furniture and lighting throughout the facility. The hot water temperature tested within regulation at 113.0 Fahrenheit. The facility has operating carbon monoxide alarms. The facility has a charged fire extinguisher. LPA Prieto observed personal rights posters, licensing documents, and the disaster plan posted throughout the facility. LPA Prieto observed that cleaning supplies, toxins, sharps, and other dangerous items are kept secure and inaccessible to residents in care. There was a designated storage space for client/staff files. LPA Prieto observed medications locked and inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient in number for residents in care. The facility has a variety of food available for clients. Dishes, cups, and utensils were also appropriately stored. Care & Supervision: The facility staff is sufficient in number for the care and supervision of residents in care. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA Prieto reviewed five (5) client files for admission agreements, updated physician reports, and needs and services plans. Medications were audited randomly and appeared to be dispensed appropriately by staff members. LPA Prieto reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator.the state’s words, verbatim · CDSS document, Aug 6, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Javier Prieto conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An initial application to operate a Residential Care Facility for the Elderly was submitted to the Central Applications Unit (CAU) on 03/14/2025 for a total capacity of 6 non-ambulatory. Fire Clearance was granted 04/10/2024. LPA Prieto met with Patsara Chantharaseth- Administrator. LPA Prieto observed the following: Structure: Facility was a single story house with four (4) bedrooms, two (2) bathrooms, living room, dining area, office space, and kitchen area. Heating/Cooling System: Central heating and air conditioning systems. Bedrooms: All bedrooms were adequately furnished with bed, chair, large closets, appropriate linens, adequate lighting, and an operational smoke alarm and fire extinguishers. Bathrooms: Bathrooms have a working toilet, wash basin, and shower with an adequate supply of towels, toilet paper, and toiletries. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Cleaning supplies and knives/sharp instruments were secured in a locked cabinet and/or drawer. There was adequate room for food storage. Refrigerator/freezer were in working condition. There was adequate seating for meals. Living/Family room: Furnished with safe and adequate seating and furnishings. All items appear to be in good repair Linens and Hygiene Supplies: An adequate supply of linens was available. Laundry detergents and cleaning solutions were secured. Yards/Outside: There was a covered area with adequate seating for staff and clients. There were no obstructions. There were no bodies of water observed anywhere on the property. Garage: Garage was organized and free of obstructions. Emergency Phone Numbers, and Exit Plan: Let-Us-No poster and clients rights are posted. General items: LPA observed a working facility phone. LPA conducted COMPONENT III with the applicant during this Pre Licensing Inspection. This facility physical plant is prepared for licensure at this time. A copy of this report was discussed and provided to Patsara Chantharaseth- Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: INTL Capacity: 6 Census : 0 Method: Telephone call with CAB COMP II Participants: Chantharaseth, Patsara (Licensee & Administrator), & Dianna Esparza,(Analyst). Licensee & administrator participated in COMP II via Telephone call with CAB Analyst. Identification of licensee/administrator was verified by confirming driver’s license numbers. During COMP II, licensee/administrator confirmed the understanding of Title 22. Component II was successfully completed. Licensee/administrator were advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed licensee's/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, May 15, 2025