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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300612933
Report Date: 08/11/2022
Date Signed: 08/11/2022 11:37:42 AM

Document Has Been Signed on 08/11/2022 11:37 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:UNITED HOME CAREFACILITY NUMBER:
300612933
ADMINISTRATOR:CANLAS, RODANTE & DELLEFACILITY TYPE:
735
ADDRESS:1012 N. LAGUNA STREETTELEPHONE:
(714) 535-4756
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 3DATE:
08/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Delle Canlas, Rodante Canlas TIME COMPLETED:
11:49 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Delle Canlas. LPA explained the reason for the visit. Delle Canlas has an Administrator's certificate that expires on 12/23/2022. LPA and Administrator toured the facility. Facility has 4 bedrooms, 1 room is for staff, 2 bathrooms, living room, kitchen, dining room and a 2 car garage. The garage is kept locked and used for storage. Smoke detectors and carbon monoxide detectors tested operational. The kitchen is clean and organized. The stove lights unassisted. LPA observed a 2 day perishable and a 7 day perishable food supply on hand in the kitchen. The fire extinguisher in the kitchen is fully charged. LPA observed emergency food and water stored in the garage. Both bathrooms are clean and operational. Hot water measured 120.3 degrees in bathroom 1 and 122.0 degrees in bathroom 2. Staff adjusted the water temperature on the water heater during the visit. LPA observed all medication is kept locked in a filing cabinet. No obstacles or hazards observed inside of the facility. LPA and Administrator toured the backyard. The backyard has a covered patio with 2 separate seating areas for clients. LPA inspected the 2 room shed in the backyard. LPA observed a small plastic shed in the backyard. The plastic shed is not locked but used to store old small furnishings. There are no hazardous items in the plastic shed. The large 2 room shed is kept locked and used for storage. Both exit gates on each side of the house are operational. No bodies of water observed. No obstacles or hazards observed in the backyard. LPA observed all staff wore masks during the visit. There are Covid-19 postings throughout the facility. LPA consulted with the Administrator concerning continued Covid-19 mitigation and reporting requirements. No deficiencies observed during the visit. No deficiencies are being cited as a result of this 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: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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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