Jason's Open Arms

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry Tsunghsien Yu, Caregiver. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Two (2) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Employee records review began- Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current; expires 05/29/2028. Corporation or LLC is active and in good standing. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 116.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. (Continued on LIC809, Page 2) (Continued from LIC809, Page 1) Laundry facilities and a cabinet is present for storing laundry soap and other chemicals in the laundry room. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA made observations throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation, and the structure remains unchanged according to the approved floor plan. LPA learned that one (1) caregiver is a live-in staff occupying resident room #5 that is designated for a resident. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 04/12/206. The facility conducting emergency disaster drills quarterly; last done 4/3/2026. Corporation is active and in good standing. Based on the information received during this visit today, zero (0) deficiency is being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with Jason Lin, and a copy provided at the time of the exit interview. LPA has requested updates to the following documents to be submitted to the CCL by 05/5/2026: LIC200 with updated sketch for changes to the floor plan, LIC308, LIC 500, LIC 610, liability insurance. *LPA was away from the facility from 12:50-1:50 PMthe state’s words, verbatim · CDSS document, Apr 28, 2026

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Seo Jeon conducted an announced visit to conduct a Pre-licensing inspection. LPA met with Chin-Wen Cheng, Applicant, for a Residential Care Facility for the Elderly (RCFE) with a capacity of six (6) residents. The facility is a single story (5) bedroom (3) bath home. There are (5) resident bedrooms, kitchen/dining area, (1) living room area, a laundry room, and a backyard. The facility does not have any bodies of water or firearms or ammunition. LPA toured the interior and exterior areas of the facility. The following were inspected: All bedrooms have the required bedding, furniture, night-stands, lighting, and emergency lighting. The bathroom appliances were operating in safe and sanitary condition. The bathrooms have non-slip surfaces and grab bars. Utensils and dishware are in good repair and ready for client use. Kitchen appliances and counter-top were free of debris and in good repair. The knives and sharp objects were locked in a kitchen cabinet. The water temperature was measured by LPA, the thermometer read at 108 degrees F. There is adequate seating in the common areas. The facility will have a storage locker that will hold resident files and staff files in the hallway. The facility will have medication locked in a hallways closet. The facility will keep the detergents and cleaning chemicals in locked laundry room. An adequate supply of clean linens and hygienic supplies for the residents were readily available at the facility. There is (1) fully charged fire extinguisher in the facility. LPA observed operating smoke detectors and carbon monoxide alarms in the facility. LPA observed required postings including the emergency/disaster plans, complaint procedures, LTCO poster, PUB475, and personal rights. The facility was equipped with a complete first aid kit and manual. Continued on LIC809-C..... LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. The Pre-licensing inspection is incomplete with the following items to be resolved by 4-28-2025. Applicant will purchase (6) chairs for resident bedrooms. Applicant will purchase (6) dressers for resident bedrooms. An exit interview was conducted, and this report was discussed and provided to Chin-Wen Cheng, Applicant.the state’s words, verbatim · CDSS document, Apr 24, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: LIN, JASON and CHENG, CHIN-WEN - Licensee/Administrator Interview Method: Telephone interview On 04/01/2025, 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, Apr 1, 2025