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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606039
Report Date: 11/06/2024
Date Signed: 11/06/2024 04:00:07 PM

Document Has Been Signed on 11/06/2024 04:00 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:A.L. HOME CAREFACILITY NUMBER:
300606039
ADMINISTRATOR/
DIRECTOR:		AMANTE, AMADO & LUZFACILITY TYPE:
735
ADDRESS:2705 S. POPLAR STREETTELEPHONE:
(714) 432-8381
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY: 6CENSUS: 5DATE:
11/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Judsen Cardinal-House Manager, Ann Amante-AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Brandon Lopez conducted an unannounced visit for the Required 1 Year Inspection. LPAs explained the purpose of today’s visit, and were greeted and granted entry by Caregiver Judsen Cardinal. Administrator (AD) Ann Amante arrived shortly after.

For today’s visit, LPAs observed a total of three clients in care and one staff member on duty.

LPAs verified the Administrator's Certificate for facility AD Ann Amante which expires on September 22, 2025.

LPAs toured the interior and exterior portions of the facility with AD Amante. The facility is a one-story home and is licensed for six ambulatory clients. There are a total of four bedrooms of which three are for clients and one for staff. LPAs toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. LPAs observed all windows were screened. Smoke and carbon monoxide detectors were tested and operational. There are a total of two restrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 112.3-115.8 degrees Fahrenheit.

Food menu was also posted and visible. LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Fire extinguisher was observed to be fully charged and mounted with service tag dated September 23, 2024. Fire extinguisher is located by the kitchen/dining room. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable.

CONTINUED ON LIC809-C...

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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: A.L. HOME CARE
FACILITY NUMBER: 300606039
VISIT DATE: 11/06/2024
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LPAs observed the emergency disaster and evacuation plan, which is located by kitchen/dining room. Facility had back-up emergency food and water supply. LPAs observed that First Aid Kit had all the required components. LPAs observed that medications and toxins were locked and inaccessible to clients in care.

For the exterior portion, LPAs observed a shaded area, patio furniture, and the grounds were free of any hazards. There is one gate in the backyard. No bodies of water were observed.

LPAs reviewed five of five client files and two staff files. LPAs also reviewed client money and ledger for five of five clients. LPAs interviewed clients and staff.

During today's visit LPAs observed clients' in the living room watching television.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with facility representative.

A copy of this report was provided at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
LIC809 (FAS) - (06/04)
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