300606971-2-20-2025-22-AS-NGUN-DE3PNU-20250220102828

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300606971
Report Date: 02/19/2025
Date Signed: 02/20/2025 10:29:34 AM

Document Has Been Signed on 02/20/2025 10:29 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:	CASA QUESADA II		FACILITY NUMBER:	300606971
ADMINISTRATOR/ DIRECTOR:	QUESADA, WILFREDO		FACILITY TYPE:	735
ADDRESS:	2341 S. TOWNER		TELEPHONE:	(714) 540-6984
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92707
CAPACITY: 6		CENSUS: 5	DATE:	02/19/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:53 PM
MET WITH:	Leopoldo Morales- Caregiver		TIME VISIT/ INSPECTION COMPLETED:	04:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Nancy Guillen conducted an unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by care giver Leopoldo Morales and LPA explained the nature of the visit. Administrator Wilfredo Quesada was notified and assisted over the phone, but was not present due to being out of town. Five clients reside at this facility, LPA was informed two clients were out in the community. At the time of visit there was only three clients present. LPA began the tour of the inside and outside of the facility with care giver. LPA observed required department postings posted on the wall of facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in an additional refrigerator in the garage. The facility is maintained at a comfortable temperature. LPA observed that medication is centrally stored in a locked storage cabinet located in the kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to clients in care. LPA inspected the bathroom and measured the hot water temperature ranging from 109.4 to 111 degrees Fahrenheit. All bathrooms observed to have a supply of soap, toilet paper and paper towels. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in the garage. The facility has an available clean supply of linens. LPA inspected client’s bedrooms which have sufficient lighting to ensure the safety and comfort of clients in care. All bedrooms observed to have all required components. Storage space is provided for clients in their bedroom. Smoke detectors and carbon monoxide were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there is shaded seating areas for client’s enjoyment. LPA observed a fire extinguisher fully charged in the kitchen. Fire drills conducted every three months with the last drill conducted on January 31, 2025. Continued on LIC 809 C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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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Document Has Been Signed on 02/20/2025 10:29 AM - It Cannot Be Edited

Created By: Nancy Guillen On 02/19/2025 at 04:08 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CASA QUESADA II	FACILITY NUMBER: 300606971
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80066(a)(11)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) Tuberculosis test documents as specified in Section 80065(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of three staff records which poses an immediate health risk to persons in care. TB test for Staff 3 (S3) reflects a positive TB test done in 2010.
	POC Due Date: 02/20/2025
	Plan of Correction
1 2 3 4	Licensee to submit corrected Health Screening Report to LPA by POC.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Armando J Lucero

LICENSING EVALUATOR NAME:

Nancy Guillen

LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 02/20/2025 10:29 AM - It Cannot Be Edited

Created By: Nancy Guillen On 02/19/2025 at 04:08 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CASA QUESADA II	FACILITY NUMBER: 300606971
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80075(f)

Health-Related Services

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of three staff files.First Aid/CPR Certification was not present at the facility which poses a potential health and safety risk to persons in care.
	POC Due Date: 02/26/2025
	Plan of Correction
1 2 3 4	Licensee to submit First Aid/CPR Certification to LPA by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Armando J Lucero

LICENSING EVALUATOR NAME:

Nancy Guillen

LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: CASA QUESADA II	FACILITY NUMBER: 300606971
	VISIT DATE: 02/19/2025

NARRATIVE

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LPA began review of records. LPA reviewed five clients’ records. All the required documentation was present and current in client’s files reviewed with the exemption of CPR/First Aid Certifications and a negative TB test for Staff #03; deficiencies were cited on today’s date. The facility P&I records were reviewed. LPAs observed that an individual log is maintained for each client. All monies are accounted for and attached receipts for record keeping. LPA reviewed three employee records. All employees present have a criminal record clearance and are associated to the facility.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC809 (FAS) - (06/04)

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