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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613124
Report Date: 12/14/2021
Date Signed: 12/14/2021 12:42:04 PM

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:ORAVILLA GUEST HOMEFACILITY NUMBER:
300613124
ADMINISTRATOR:WALLACE, EVELYNFACILITY TYPE:
740
ADDRESS:2906 E HOOVERTELEPHONE:
(714) 639-1465
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY:6CENSUS: 5DATE:
12/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:34 AM
MET WITH:Evelyn Wallace, AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs) Ruth Martinez and Kevin Saborit-Gausch conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by caregiver. LPAs explained the nature of the visit. Evelyn Wallace, Administrator arrived shortly after and met with LPAs.

LPAs accompanied by caregiver began the tour of the inside and outside of the facility. There are five residents in care and there are no active covid-19 cases in the facility. LPAs observed a check in station in the main entry of the facility. Facility is taking temperatures daily to both residents and visitors and documenting the results. Residents temperatures are being taken twice a day. LPAs observed required department postings, covid-19 precautionary posting, and hand washing signs throughout the facility. LPAs observed the emergency and disaster and evacuation plan posted. Facility has an emergency supply of food and water stored in attached garage. Facility has ample supply of PPE supplies stored in attached garage. LPAs inspected residents’ bedrooms and they appeared to be clean and sanitary. All bedrooms observed to have all required components. LPAs observed residents in their bedrooms relaxing and/or watching TV. All residents appeared to be clean and well taken care of. All restrooms were observed to have supply of soap/sanitizer and appeared to be clean. LPA observed the outside of the facility and observed a shaded seating area for resident’s enjoyment as well as additional seating areas throughout the backyard. LPAs were informed by Administrator that staff and residents have received the covid booster shot. The facility has completed the LIC808 Mitigation Plan, LPA Martinez reviewed and approved the plan on today’s visit. LPA emailed the signed and approved plan to the Administrator for their records.

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.
This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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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