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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605448
Report Date: 01/17/2025
Date Signed: 08/11/2025 08:49:08 AM

Document Has Been Signed on 08/11/2025 08:49 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ASHLING'S RESIDENTIAL VILLAFACILITY NUMBER:
300605448
ADMINISTRATOR/
DIRECTOR:		SUSAN ASHLINGFACILITY TYPE:
735
ADDRESS:362 E. 20THST.TELEPHONE:
(949) 645-1435
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 37CENSUS: 37DATE:
01/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Waldo ContrerasTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA met with Administrator (AD) Waldo Contreras and discussed the purpose of the inspection.

During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, and observed the following:

The facility consists of three buildings. The central front building is one story and consists of three staff offices, one bathroom, a living room, kitchen, and dining room. Located in the back are two two-story apartment complexes, consisting of a total of 12 apartments, of which 11 are occupied by clients, and one by staff. Select client apartments were inspected and all were observed to have the required furnishings. LPA observed all client beds had linens and blankets. There is a courtyard with multiple shaded sitting areas. LPA observed clients socializing in common areas and resting in their respective apartments. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 105.0-120.5 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 extinguishers were observed to be fully charged with service tags dated September 10, 2024. Facility appliances were inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to clients. Medication was observed to be centrally stored and locked in a medication cart. LPA reviewed centrally stored medication for select clients and did not observe any discrepancies. LPA reviewed five client files and four staff files. LPA interviewed five clients and three staff.

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.

NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: Claudia Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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