Facility Evaluation Report

Licensing Program Analysts (LPAs) Sean Haddad and Claudia Gutierrez conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPAs met with Administrator (AD) Paul Chea, discussed the purpose of the inspection, and toured the facility. Facility is to operate an Adult Residential Facility. Application was submitted to Community Care Licensing on 01/03/2022. This is a Change of Location from BEVERLY HOME (306004725) 9811 Beverly Lane, Garden Grove, CA 92841.

During the inspection, LPAs and AD observed the following: Structure. This is a one-story home. Facility is a 4-bedroom, 2-bathroom, 1 story house with attached garage that is being used for storage. There is a back yard with a patio cover for the clients. AD stated they will add additional shade and outdoor furniture for the clients. Facility telephone number is (714) 537-6530. Client Bedrooms. The 4 client bedrooms are spacious and will easily accommodate the client's furnishings. Lamps, chairs, linens, and storage for each client bedroom will be relocated the same day as the clients when the change of location has been approved. Bedrooms staff. This facility has no staff bedrooms. Bathrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 115 to 116.6 F degrees. Linens & Hygiene Supplies. Linen closets were observed. Linens will be relocated the same day as the clients when the change of location has been approved. Emergency Phone Numbers, Exit Plan & Menu: Reviewed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the wired smoke detector and the carbon monoxide detector. Food Service. 2 days perishable and 7 days nonperishable food supply will be relocated the same day as the clients when the change of location has been approved. Appliances. New Stove burners, washer, and dryer inspected. Additional appliances will be relocated the same day as the clients when the change of location has been approved. Knives: will be locked/stored in the cabinet. Toxins: will be locked under the sink and in the garage. Medication will be stored in a locked cabinet. Medications will be relocated the same day as the clients when the change of location has been approved. First-Aid Kit & Activity Supplies: will be relocated the same day as the clients when the change of location has been approved.