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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000159
Report Date: 02/23/2023
Date Signed: 02/23/2023 11:38:13 AM

Document Has Been Signed on 02/23/2023 11:38 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CATHERINE'S HOMES, INC.(534 WEST AVE)FACILITY NUMBER:
306000159
ADMINISTRATOR:CARLO M.P. GONZALESFACILITY TYPE:
735
ADDRESS:534 W WEST AVETELEPHONE:
(714) 525-2841
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 6CENSUS: 6DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Michael San Diego, AdministratorTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by care staff and explained the nature of the visit. Michael San Diego, Administrator arrived shortly after and met with LPA.

LPA Martinez accompanied by care staff and Administrator began the tour of the facility. There are six clients in care and LPA was informed all clients were out in the community. Upon arrival to the facility LPA observed a sanitation station on the outside of the front door prior to entering the facility. Upon entry to the facility there is a check in station with a sign in procedure and temperature checks. LPA observed required department postings, mitigation plan, covid precautionary postings, and hand washing signs posted at the facility. The facility has an Emergency Disaster Plan in place. There is a minimum of one week of non-perishables and two days of perishables foods available. The facility has an emergency food and water supply on site. Facility has an ample supply of hygiene, cleaning and disinfecting products. Personal protective equipment (PPE) supply is available. All bathrooms observed to have a supply of soap, toilet paper and paper towels. LPA toured the client’s bedrooms, all bedrooms observed to have all required components. Facility has a secure location for medication and has a 30 day supply of medication for clients. LPA toured the outside of the facility and observed a covered patio with seating for client’s use.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected 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.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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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