Facility Evaluation Report

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Henry Balanza, 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 09/22/2023. This is a change of facility type with persons in care. Facility is currently operating as a Group Home. Facility has a granted age exception for 1 under-age client.

During the inspection, LPA and AP observed the following: Structure: this is a one-story home. Facility is a 5-bedroom, 2-bathroom, one-story home with detached garage that is being used for storage. Facility telephone number is (714) 591-5422. Client Bedrooms: the 4 client bedrooms are spacious and will easily accommodate the clients’ furnishings. Lamps, chairs, linens, and storage for each client bedroom inspected. Staff Bedrooms: LPA inspected the 1 staff bedroom. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 113 degrees F in the common bathroom near the client rooms and 117.8 in the common bathroom near the kitchen. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: 2 days perishable and 7 days nonperishable food supply reviewed. 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 is locked. First-Aid Kit & Activity Supplies: observed and available. Client & Staff Files: LPA reviewed 4 client files and 2 staff files. Fire clearance was approved by Orange County Fire Authority on 11/14/2023. Backyard exit gate is operational and unlocked. Back yard has shaded area for outdoor activities and sufficient seating for clients. Component III was completed with AP during today’s inspection. Facility is currently operating under the liability insurance of current facility SERENITY HOME (306004227). AP will switch liability insurance to new facility once the application is approved. The facility is ready for licensure pending final review of documents.