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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606971
Report Date: 02/17/2022
Date Signed: 02/17/2022 10:38:43 AM

Document Has Been Signed on 02/17/2022 10:38 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CASA QUESADA IIFACILITY NUMBER:
300606971
ADMINISTRATOR:QUESADA, WILFREDOFACILITY TYPE:
735
ADDRESS:2341 S. TOWNERTELEPHONE:
(714) 540-6984
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 6CENSUS: 5DATE:
02/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Administrator Wilfredo Quesada TIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Wilfredo Quesada and stated the purpose of this visit.

The facility is a single level structure and licensed for six ambulatory of which 2 may be non-ambulatory; and is accredited under Regional Center of Orange County as a level III facility.

About 9:39 AM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. LPA toured the interior and exterior portions of the facility. LPA observed four clients and two staff members on the floor. 1 client was out attending a day program. There were 3 shared client's rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide alarms were tested to be operational. Bathrooms were observed to be in good repair. Hot water was measured at 111 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to clients in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had outside furniture in good repair. Side exit door was self-latching; and self-latching. LPA Marin reviewed the COVID 19 mitigation plan of the facility.

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

LPA Marin advised AD Wilfredo Quesada to use general office email to send all reports: CCLASCPOrangeCountyRO@dss.ca.gov

LPA Marin conducted an exit interview with AD Wilfredo Quesada and copy of this report was left in the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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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