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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803389
Report Date: 01/04/2024
Date Signed: 01/04/2024 02:22:05 PM

Document Has Been Signed on 01/04/2024 02:22 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:SAAFIR, AHMEDFACILITY TYPE:
735
ADDRESS:2103 ORANGE AVENUETELEPHONE:
(562) 599-0856
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 36CENSUS: 23DATE:
01/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:MANAGER NATE STOCKARDTIME COMPLETED:
02:30 PM
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On 01/04/2024 around 12:30pm Licensing Program Analyst (LPA) Jose Calderon initiated an unannounced Case Management visit – Deficiencies the above said facility Orange Community Care. Today’s visit was conducted face to face with Manager Nate Stockard.

On 01/04/2024 LPA Calderon tour the facility which consisted of a multi-story (2) commercial apartment building to include all common areas which included but were not limited to building entrances, reception areas, office, hallways, restrooms, dining room, kitchen, pantry, apartment 1, 2, 3 and 4. LPA Calderon also reviewed the facility's entry procedures, body temperature monitoring practices, social distancing practices, protective facial covering practices and disinfection/sanitation practices with Manager Nate Stockard.

On 01/04/2024 LPA Calderon interviewed Manager Nate Stockard for case management visit. Manager Stockard states that major changes have been made and the manager understands that the upkeep of the facility helps clients’ lives. LPA Calderon toured the facility and noted all trash is picked up. The major holes in the walls caused by residents have been repaired. LPA Calderon noted bathrooms were clean and had toilet lids, the showers were working and clean. The apartment had a fire and repairs are in process. The outside grounds are free of trash and the 2-washing machine have been removed. LPA Calderon reviewed the P&I log notes for 5 random clients and there are no errors found.

An exit interview was conducted with Manager Nate Stockard, and a hard copy was provided by hand for signature.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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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