300606862-8-30-2024-22-AS-EKIM-D8MQ59-20240830115135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300606862
Report Date: 08/30/2024
Date Signed: 08/30/2024 11:52:08 AM

Document Has Been Signed on 08/30/2024 11:52 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	HUNTINGTON BEACH GUEST HOME II		FACILITY NUMBER:	300606862
ADMINISTRATOR:	L. MANGURAY, N.& W.URETA		FACILITY TYPE:	740
ADDRESS:	8382 CRANE CIRCLE		TELEPHONE:	(714) 536-2375
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY:	6	CENSUS: 6	DATE:	08/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Loida Manguray		TIME COMPLETED:	12:05 PM

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On August 30,2024 8:00am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (AD) Loida Manguray and explained the purpose of the visit.

The facility is licensed to operate for six (6) non-ambulatory residents and have a hospice waiver for 3 residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living area, dining area, kitchen, and outside covered patio area.

LPA Kim toured inside and outside of the physical plant with AD Manguray. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Resident Room 5, Resident Room 6, and staff room. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between at 109.9 degrees F and 111.3 degrees F in Resident 2 Bathroom. A comfortable temperature of 73 degrees F was maintained in the facility.

LPA Kim observed the facility to be sanitary and appropriately furnished. The facility has operable smoke detectors and carbon monoxide detectors. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food is stored in the kitchen pantry. A working telephone (714-536-2375) remains available.. Fire Extinguisher was fully charged, mounted in the kitchen, and serviced on April 10, 2024. First Aid Kit is complete and has all the necessary elements.

Evaluation Report Continues on LIC 809-C

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (916) 956-7332
LICENSING EVALUATOR NAME: Edward Kim	TELEPHONE: (714) 293-1237
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

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: HUNTINGTON BEACH GUEST HOME II	FACILITY NUMBER: 300606862
	VISIT DATE: 08/30/2024

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During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Emergency drills are conducted quarterly and last conducted on June 15, 2024.

LPA Kim conducted an audit of residents #1-6 (R1-R6) files, and staff #1-#3 (S1-S3) l files, and medication were all in order and complete. LPA Kim conducted 1 staff interview and 1 resident interview.

No deficiencies were cited during this visit.

An exit interview was conducted and a copy of this report was provided to Administrator Loida Manguray.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (916) 956-7332
LICENSING EVALUATOR NAME: Edward Kim	TELEPHONE: (714) 293-1237
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

LIC809 (FAS) - (06/04)

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