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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613124
Report Date: 01/16/2025
Date Signed: 01/16/2025 09:44:46 AM

Document Has Been Signed on 01/16/2025 09:44 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:ORAVILLA GUEST HOMEFACILITY NUMBER:
300613124
ADMINISTRATOR/
DIRECTOR:		WALLACE, EVELYNFACILITY TYPE:
740
ADDRESS:2906 E HOOVERTELEPHONE:
(714) 639-1465
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
01/16/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:37 AM
MET WITH:Leonides ArceoTIME VISIT/
INSPECTION COMPLETED:
10:05 AM
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On January 16th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting a plan of correction visit. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Leonides Arceo.Shortly after LPA set up equipment administrator arrived and LPA Vanegas observed the following.

Licensee/administrator has made the following corrections. Administrator documented and completed required annual training for all staff members. Administrator also began the implementation of the medication administration record (MAR) and medication that is being given to residents is organized.

LPA Vanegas observed a new administrator record, and all required documents were included in the administrator record. LPA Vanegas also reviewed updated and active liability insurance to be on the facility premises and filed in facility record. All plans of correction have been completed and cleared.

After today's visit no deficiency's have been cited. An exit interview was completed and a copy of this report was left at the facility.
Armando J LuceroTELEPHONE: (714) 703-2866
William VanegasTELEPHONE: (714) 497-7621
DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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