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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606700
Report Date: 02/04/2025
Date Signed: 02/04/2025 03:54:19 PM

Document Has Been Signed on 02/04/2025 03:54 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:MALDONADO, ELIZABETH HOMEFACILITY NUMBER:
300606700
ADMINISTRATOR/
DIRECTOR:		MALDONADO, ELIZABETHFACILITY TYPE:
735
ADDRESS:10282 ARUNDELTELEPHONE:
(714) 531-5226
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 6CENSUS: DATE:
02/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:11 PM
MET WITH:Elizabeth MaldonadoTIME VISIT/
INSPECTION COMPLETED:
04:09 PM
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by Administrator (AD) Elizabeth Maldonado. The facility is licensed for 6 ambulatory clients only. Currently there are 4 clients living here during today's visit.

At 1:24 PM, LPA Tea reviewed four client files and one staff files. Client files and staff files contained all required documentation except one minor issue, there are no client admission agreements that meets Title 22. Client records contain Orange County Regional Center admission agreements. LPA advised AD to draft admission agreements based on Title 22. The administrator certificate expires on March 19, 2025.



LPA Tea along with the administrator toured the facility at 2:00 PM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a two-story home with four client bedrooms, one staff room, and three bathrooms. The facility has a kitchen, family room, dining room, and living room with an attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each client comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured around 105.2 degrees. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit.

Continuation of annual report on LIC809C

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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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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: MALDONADO, ELIZABETH HOME
FACILITY NUMBER: 300606700
VISIT DATE: 02/04/2025
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LPA observed sharps and toxins to be secured and locked and inaccessible to clients in the staff room. Fire extinguishers are fully charged throughout the facility. The facility’s last fire drill was conducted on January 18, 2025. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating with shade. LPA observed emergency supplies, food, and water in the front entryway closet. LPA Tea observed clients relaxing in their rooms and coming back from their day program. The staff provide activities based on client’s personal preference, the clients like to go on outings a lot, especially bowling.

At 2:25 PM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the garage. Medications are being administered per physician order. P&I Funds were checked and meet department standards. LPA interviewed clients regarding their quality of care.



Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with administrator Elizabeth Maldonado and a copy of this report LIC809, 809-C, LIC858, LIC859, and LIC9102TV was read and provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
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