Phamily Home Elderly Care 3

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by care provider Naomi Pena and Monique Rojas after explaining the purpose of the visit. Administrator (AD) Charles Pham was notified via telephone and later arrived to assist with the inspection. LPA observed the Administrator's Certificate was current with and expiration date of May 19, 2027. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents of which one may be bedridden. The facility is a one-story home with five resident bedrooms, three bathrooms, a living room, kitchen and an attached garage. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms and observed the following: LPA observed residents watching television in the living room and resting in their respective bedrooms. LPA observed five residents in care and two staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall by the facility entrance. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the garage. LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. LPA observed all windows were appropriately screened. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 120.9 and 127.2 degrees Fahrenheit; a deficiency was cited on today's date. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use. Continued on LIC 809C LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a purchase date of June 17, 2026 and located in the hallway. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. LPA observed knives and sharps to be stored in a locked kitchen drawer. The garage is used for storage which stores the facilities toxic chemicals, cleaning solutions, and disinfectants. Medication cabinet was observed to be locked and centrally stored in the living room closet by the facility entrance. LPA observed over the counter medications were administered to residents without a doctor's order; a deficiency was cited on today's date. LPA observed the First Aid Kit had all the required components. LPA observed the facility conducted their last emergency disaster drill on May 17, 2026 and is conducted every 3 months. LPA began review of the records. LPA reviewed five resident records. All the required documentation were present and current in the resident files reviewed. LPA reviewed three employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPA observed records reviewed have a current First Aid certificate. Licensee was made aware of pending annual fees and paid during LPA's visit. Based on the observations made during today’s inspection, deficiencies are being cited. An exit interview was conducted and a copy of this report and appeal rights and Legionnaire’s Disease fact sheet was left at the facility.the state’s words, verbatim · CDSS document, Jun 17, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Marjorie Bautista. LPA met with Staff Yuridia “Yuri” Grijalva and explained the purpose of the inspection. Licensee Charles Pham was contacted by phone and arrived at approximately 1:30 p.m. During the inspection, LPA and Staff Grijalva conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with five bedrooms, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 113.0 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and medication closet was observed to be locked. LPA reviewed three resident files and two staff files. LPA interviewed two residents and two staff. (Cont. LIC809-C) Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with Licensee Charles Pham. An application to operate a Residential Care Facility for the Elderly (RCFE) for (6) capacity, (3) ambulatory, (2) non-ambulatory, and (1) bedridden residents was received by CCL on January 29, 2024. Structure: The facility is a one-story house with five bedrooms, three bathrooms, a living room, a kitchen, and attached two car garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entranceway. There is a backyard that wraps around to the front yard on one side of the home and an exit gate on the opposite side. There is a shaded seating area in both the front and back yard of the home, and LPA did not observe any obstacles or hazards. Resident Bedrooms All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. Signal system There is no signal system. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored and locked underneath the kitchen sink and in the garage. Medications, First-Aid Kit & Book: Medication will be stored in a locked closet. First aid kit is stored with the medication. The first aid kit has all the required elements. Resident & Staff Files: Records will be kept in a locked file cabinet. Pool/Jacuzzi: No bodies of water were observed. Fire Extinguisher: Fire extinguishers are fully charged. Reading Material, Games, Equipment & Materials: The facility has magazines, board games, puzzles, and other recreational materials for resident use stored in the living room and hallway storage. Fire clearance: Was approved by a fire inspector of Anaheim Fire Department on March 11, 2024. Special conditions noted, “Bedridden = Bedroom #4. Non-ambulatory = Bedroom #5” Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. Bedrooms Staff: There is no staff bedroom. Bathrooms: All bathrooms have working plumbing. Hot water measured between 106.5- and 112.0- degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen was stored in the hallway storage. Emergency Phone Numbers, Exit Plan & Menu: Posted and available, means of exiting, and emergency phone numbers. Food menu was also posted. Food Service: A supply of 2-day perishable and 7-day of non-perishable food was observed and will be maintained on hand. Smoke Detectors: Smoke detectors and carbon monoxide detectors tested operational. Appliances: Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. Licensee was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided to Licensee.the state’s words, verbatim · CDSS document, Jun 6, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Charles Pham and Jeffrey L Gardner - Applicant/Administrator Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 04/23/2024, 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, Apr 23, 2024