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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000106
Report Date: 02/27/2025
Date Signed: 02/27/2025 04:51:47 PM

Document Has Been Signed on 02/27/2025 04:51 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:PROMISES GUEST VILLAGEFACILITY NUMBER:
306000106
ADMINISTRATOR/
DIRECTOR:		DANTE ENCARNACIONFACILITY TYPE:
735
ADDRESS:1315-1321 ANAHEIM BLVD.TELEPHONE:
(714) 774-1544
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 40CENSUS: 40DATE:
02/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:32 PM
MET WITH:Dante EncarnacionTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On February 27th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection for the purposes of an annual inspection. Upon arrival LPA Vanegas met with Administrator (AD) Dante Encarnacion and explained the purpose of the inspection. LPA Vanegas began a tour of the facility and observed the following.

This is a larger facility with a capacity of 40 clients, there is 20 rooms which are all shared rooms. There is a large outdoor shaded courtyard where clients were observed to be enjoying their leisure time and socializing with one another.

LPA Vanegas observed there to be a large dining area with food menus offering a different variety of food. LPA Vanegas observed all sharps, toxins, and medications to be locked away and inaccessible to clients in care. LPA Vanegas observed there to be a two day supply of perishable food and a seven day supply of non-perishable food available for clients in care.

LPA Vanegas observed all fire extinguisher to be fully charged and up to date. LPA Vanegas observed emergency drill log and smoke detector and carbon monoxide detector test logs. LPA Vanegas observe all client bathrooms to be clean and free of mildew and debris. Water faucets and toilets tested operational. Water tested to be between 116.4 and 118.8 degrees.

LPA Vanegas observed all client rooms to have required furnishings such as chest drawers, lamps, chairs, a bed, and clean linens in good repair; meaning no strains or tears. LPA Vanegas observed rooms to be big enough to move around freely, and be free of any obstructions.

CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PROMISES GUEST VILLAGE
FACILITY NUMBER: 306000106
VISIT DATE: 02/27/2025
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LPA Vanegas observed for there to be no obstructions a long the emergency exit paths, and all side doors were self latching with no locks on them. LPA Vanegas observed facility to have a first aid kit with all required items in it such as tweezers, scissors, adhesive tape, and a termometer.

LPA Vanegas reviewed P&I with AD and observed all balances to be accounted for and up to date. LPA Vanegas reviewed medications with AD and observed for medications to be documented when they are administered. Per LPA Vanegas review medications are being administered per physicians orders.

LPA Vanegas reviewed four client files and three staff files. All files (Staff and Client) had the accurate information in them and all staff training was completed timely.

Based on observations made during today's visit no deficiencies will be cited per title 22 chapter six of the California Code Of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC809 (FAS) - (06/04)
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