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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606862
Report Date: 08/01/2022
Date Signed: 08/01/2022 01:26:30 PM


Document Has Been Signed on 08/01/2022 01:26 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:HUNTINGTON BEACH GUEST HOME IIFACILITY NUMBER:
300606862
ADMINISTRATOR:L. MANGURAY, N.& W.URETAFACILITY TYPE:
740
ADDRESS:8382 CRANE CIRCLETELEPHONE:
(714) 536-2375
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY:6CENSUS: 4DATE:
08/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Administrator, Loida MangurayTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted, granted entry into the facility by Administrator and explained the reason for the visit.

During the visit LPA's temperature was checked. LPA toured the facility with Caregiver Jamie Oca. During visit, Administrator Loida Manguray was present during visit and licensee Norma Ureta arrived during visit. Facility is a 7 bedroom,( 6 resident bedrooms and 1 staff bedroom) and 3 bathroom single story home. There are 4 Residents in care. LPA observed proper covid signage at front entrance of facility as well as sign in, sanitization and temperature check station. Facility has required Department postings. LPA observed copy of Administrators Certificate expiring April 30, 2024. LPA toured all Residents rooms, all rooms where within department guidelines. All restrooms observed contained soap, toilet paper, wipes and paper towels. Restrooms had proper hand washing signs posted. Residents were observed relaxing in the bedrooms watching TV and listening to music in living room. Facility has operating smoke detectors. Facility has 1 fire extinguisher which is mounted and fully charged. Facility has ample supply of PPE. Facility has refrigerator with ample food supply. LPA observed facility has emergency food and water supply. Facility has required Emergency Disaster Plan. Facility has a secured location for resident medication and files. Facility has 30 days supply of medications for residents. During today's visit, LPA observed 4 of 4 resident files. Resident emergency contact information and Physicians reports are current. Facility has a designated visitation area.

No deficiencies noted during todays visit. An exit interview was conducted with Administrator and a copy of report was left at facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2022
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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