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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606032
Report Date: 10/01/2024
Date Signed: 10/01/2024 04:10:44 PM

Document Has Been Signed on 10/01/2024 04:10 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:JASMINE GARDENFACILITY NUMBER:
300606032
ADMINISTRATOR/
DIRECTOR:		HALAHAN, ELIZABETHFACILITY TYPE:
735
ADDRESS:1329 N. JASMINE ST.TELEPHONE:
(714) 776-8582
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 8CENSUS: 7DATE:
10/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Elizabeth Halahan- AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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Licensing Program Analysts (LPAs) Jessica Cho and William Vanega arrived at the facility unannounced for the purpose of conducting the Required 1 Year evaluation using the Care Inspection Tool. No staff and clients were present to grant LPAs entry. Administrator Halahan arrived at the facility approximately 11:55am after initiating phone contact.

The facility is a single story home located in a residential neighborhood. Facility offers at a Service level 2 and is licensed to serve eight (8) ambulatory clients. The client census is seven and two staff were on duty.

LPAs along with Administrator Elizabeth Halahan conducted the tour of the physical plant. Facility consists of five client bedrooms and three client bathrooms. There is an additional private bedroom and bathroom for the live-in staff. LPAs observed the facility to be clean, sanitary, and in good repair. The common areas were inspected including the detached two car garage which is used as a storage. The clients' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The water temperature measured at 115.7, 114.6, and 113.0 degrees Fahrenheit. The indoor temperature was within a comfortable range. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPAs observed adequate supply of two day perishables and seven day non-perishable food. LPAs toured the outside grounds. LPAs observed the outdoor passageway free of obstruction. The exit gate was self-closing and self-latching. LPA observed sufficient seating and shading in the front yard. There is a storage box with beach supplies at the front of the property. Facility maintains a fire extinguisher which was mounted, charged, and serviced on October 1, 2024. The smoke/carbon monoxide detectors were tested and operational. LPA observed the emergency disaster supplies including food/water in the medication closet located by the entry way. The first aid kit contains all necessary elements. Emergency evacuation drills are conducted evidenced by the emergency drill logs. A working facility telephone number, (714) 776-8582, remains available.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: JASMINE GARDEN
FACILITY NUMBER: 300606032
VISIT DATE: 10/01/2024
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During today's visit, LPA conducted an audit of seven client files and two personnel files. No discrepancies with client files. Staff training records were not readily available for review in two out of the two staff files reviewed as they were located in the administrator's office at the time of the inspection. Medications were audited for seven clients. No discrepancies noted. The Personal & Incidental (P&I) Funds were not audited as the ledgers were also at the office. LPAs observed available funds maintained at the facility for the client to use. Interviews were conducted with two out of the seven clients and one out of two on staff on duty. The remaining clients were grocery shopping with the staff.

The administrator was advised to ensure all records are readily available for review at all times.

Based on the observations made during today's visit, no deficiencies are cited. Technical Advisories are being issued.

An exit interview was conducted with Administrator Elizabeth Halahan, and a copy of this report was provided at the end of the visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
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