<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
300612933
Report Date:
08/30/2021
Date Signed:
08/30/2021 12:54:10 PM
Document Has Been Signed on
08/30/2021 12:54 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
CCLD Regional Office
,
770 THE CITY DR., SUITE 7100
ORANGE
,
CA
92868
FACILITY NAME:
UNITED HOME CARE
FACILITY NUMBER:
300612933
ADMINISTRATOR:
CANLAS, RODANTE & DELLE
FACILITY TYPE:
735
ADDRESS:
1012 N. LAGUNA STREET
TELEPHONE:
(714) 535-4756
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92801
CAPACITY:
6
CENSUS:
4
DATE:
08/30/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:52 AM
MET WITH:
Delle Canlas, Rodante Canlas
TIME COMPLETED:
01:11 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 Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA and staff toured the facility. All the bedrooms had the required furnishings. The bathroom was clean and operational. Smoke detectors tested operational. LPA observed medication locked in a file cabinet. LPA inspected the first Aid kit. First Aid kit had all the required elements. LPA inspected the kitchen. The kitchen was clean and organized. Knives and cleaning supplies were kept locked under the sink. LPA inspected the garage. The garage is used for storage and has extra food and supplies. LPA observed 2 day perishable and 7 day non- perishable food supply on hand. Administrators Rodante & Delle Canlas arrived at 12:16pm. LPA toured the outside of the facility. No bodies of water observed. The two room shed is used for storage. LPA observed boxes of supplies and tools in both rooms of the shed. The shed is kept locked. Both exit gates on each side of the house are operational. No obstacles or hazards were observed in the backyard. LPA observed Covid-19 signs throughout the facility. Facility mitigation plan is pending review. No deficiencies are being cited as a result of today's visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME
:
Luz Adams
LICENSING EVALUATOR NAME
:
Joseph Alejandre
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/30/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1