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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613124
Report Date: 12/15/2022
Date Signed: 12/15/2022 11:50:09 AM


Document Has Been Signed on 12/15/2022 11:50 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:ORAVILLA GUEST HOMEFACILITY NUMBER:
300613124
ADMINISTRATOR:WALLACE, EVELYNFACILITY TYPE:
740
ADDRESS:2906 E HOOVERTELEPHONE:
(714) 639-1465
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY:6CENSUS: 6DATE:
12/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Evelyn WallaceTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jessica Cho arrived at Oravilla Guest Home to conduct an unannounced Required 1 Year Inspection with an emphasis on Infection Control. At 10:18am, LPA Cho was greeted and granted entry by Caregiver Leonides Arceo followed by Caregiver Michael Villanueva. LPA completed the Coronavirus 2019 (COVID-19) screening procedure upon entry. There are no active COVID-19 cases as of today. LPA observed a thermometer at the check-in station and the required COVID-19 precautionary signs posted on the entrance door and throughout the facility. The Complaint Poster (PUB475) was observed in the size of 8.5" x 11" which did not meet the size requirement. At 10:27am, LPA began the tour with Caregiver Arceo, and Administrator (Admin) Evelyn Wallace joined the tour approximately 10:45am. There are a total of four resident bedrooms and three resident bathrooms. There is one private staff bedroom. LPA checked the resident bedrooms. The resident bedrooms had the required furnishings. The resident bathrooms were checked. The toilets worked properly, showers were free of mold/mildew, grab bars were secure, and slip mats were in place. Bathrooms were adequately stocked with hand soaps and paper towels and hand washing signs were posted. The hot water temperature in the resident bathrooms measured at 113.1 degrees Fahrenheit in Bathroom #1, 125.9 degrees Fahrenheit in Bathroom #2, and 127.7 degrees Fahrenheit in Bathroom #3. Perishable and non-perishable food supplies were checked and adequately stocked at the time of the visit. Smoke/carbon monoxide detectors and auditory devices were tested and operational. The fire extinguisher was mounted and charged, but facility was unable to provide the purchase receipt. Medications, toxins, and sharps were locked and inaccessible to the residents. LPA Cho toured the outside grounds. There was shading and sufficient seating for residents. The exit gates were self-closing and self-latching. Facility did not have emergency food/water supply and had sufficient supply of PPEs.

Based on the observations made during today's visit, no deficiency is being cited as per Title 22 Division 6 Chapter 2 of the California Code of Regulations. Advisory Notes (LIC9102s) were issued during the visit. An exit interview was conducted with Administrator Evelyn Wallace, and a copy of this report was provided during this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022
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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