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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803389
Report Date: 08/01/2026
Date Signed: 08/01/2026 01:04:10 PM

Document Has Been Signed on 08/01/2026 01:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:ORANGE COMMUNITY CAREFACILITY NUMBER:
197803389
ADMINISTRATOR/
DIRECTOR:		SAAFIR, AHMEDFACILITY TYPE:
735
ADDRESS:2103 ORANGE AVENUETELEPHONE:
(562) 599-0856
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 36; 36CENSUS: 25DATE:
08/01/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Ahmed Saafir & Nate StockardTIME VISIT/
INSPECTION COMPLETED:
12:29 PM
NARRATIVE
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On August 1, 2026, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced case management visit at the facility. Upon arrival, the LPA performed a risk assessment and explained that the purpose of the visit was to conduct a health and safety inspection. At the time of the visit, there were 5 clients in Building #1 and 20 clients in Building #2.

The LPA observed three staff members present during the visit. Stockard was monitoring Building #2. A plant inspection revealed no bodies of water or obstructions on the premises. All rooms in both buildings were inspected. Storage areas for personal hygiene items, cleaning supplies, toxins, and sharp objects were secured and kept out of the clients' reach. The kitchen was inspected, and there was a sufficient supply of both perishable and non-perishable food, all of which was properly maintained. Fire extinguishers were charged, and both smoke detectors and carbon monoxide detectors were operational.

The LPA noted that the Emergency Disaster Plan (LIC 610) was posted, along with the Activities Calendar. Emergency food supplies and personal protective equipment (PPE) were adequately stocked. A working landline and internet services were also operational. However, during the visit, the LPA observed that smoke detectors in Room #5A and Room #6A were non-operational.

Based on interviews, observations, and record reviews, the licensee violated the California Code of Regulations (CCR) of Title 22, Division 6, Chapter 1.

Deficiencies were documented, and an exit interview was conducted with Nate Stockard. A copy of this report is provided along with the appeal rights.
Janae Hammond
Ernand Dabuet
DATE: 08/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/01/2026 01:04 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 08/01/2026 at 11:36 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/02/2026
Section Cited
CCR
80087(a)

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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement was not met as evidenced by:
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Licensee will adhere to Title 22 80078(a) and ensure all emergency devices smoke detectors are in working condition. POC due 08/02/26 to attn: Ernand Dabuet at 424-544-1016.
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Base on observation, the licensee did not ensure that all smoke dectectors were operable. Rooms #5A and 6#A did not have working smoke detectors. This violation poses/posed an immediate risk to persons in care.
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Corrected during visit 08/01/26

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Janae Hammond
NAME OF LICENSING PROGRAM MANAGER:
Ernand Dabuet
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2026


LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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