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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000198
Report Date: 10/20/2022
Date Signed: 10/20/2022 11:47:59 AM

Document Has Been Signed on 10/20/2022 11:47 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:ORANGEWOOD VILLAFACILITY NUMBER:
306000198
ADMINISTRATOR:MANSUETO T. CONANAN JR.FACILITY TYPE:
735
ADDRESS:7801 ORANGEWOOD AVENUETELEPHONE:
(714) 897-8797
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY: 6CENSUS: 6DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Mansueto ConananTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year infection control annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. LPA Haley was temperature checked and screened before entering the facility. Administrator (AD) Mansueto Conanan was present for the visit. AD Conanan has a current administrators certificate that expires 03/11/24.

At 9:50 AM LPA Haley and AD Conanan began the inspection at the entrance of the facility. A screening station with hand sanitizer and screening logs was observed right next to the front door. There were six clients present during the visit. Near the front door there is a client room and bathroom. There's also a closet near the front door use for staff clothing.

Clients bedrooms were clean, organized, and had all necessary requirements: night stand, chair, lamp and storage space. The client bathroom were clean and organized. Hot water temperature was measured at 108.8 degrees Fahrenheit in bathroom #1 and 113.3 degrees Fahrenheit in bathroom #2. In the hallway cabinets near the client rooms, LPA observed plenty of clean linen.

LPA Haley observed a locked medication cabinet in the living room used to store client medication. There's an open office room with a desk and computer. In the office LPA observed a locked cabinet with client and staff files. An emergency supply of PPE supplies: N95 face mask, hand sanitizer, gowns and gloves was observed in the locked cabinet .

The kitchen entrance is blocked by a child safety gate and remains locked and inaccessible to clients. In the kitchen LPA Haley observed knives and sharp objects locked in a drawer next to the sink. All burners on the stove were operational. All hazardous chemicals were locked under the kitchen sink. LPA Haley observed a 2 day supply of perishable items and a 7 day supply of non-perishable items.


Continued on LIC 809 C
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ORANGEWOOD VILLA
FACILITY NUMBER: 306000198
VISIT DATE: 10/20/2022
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Further, LPA Haley observed a large plastic emergency food container that expires in 2037. Two first aid kits with all the required elements was observed in the kitchen, as well a full charged fire extinguisher mounted on the wall near the sink.

The backyard had clear walkways, free of tripping hazards. There was a side exit gate that was self closing and self latching. LPA Haley observed a shaded patio area with tables, chairs and a treadmill. Further, a washing machine, dryer, and a lock storage container used to store miscellaneous items for the clients was observed under the shaded patio area. Two locked storage sheds were observed in the backyard. One shed was used for the storage of facility supplies like adult diapers, and the second shed was used to store tools. In the garage, the walkways were clear and free of tripping hazards. LPA Haley observed plenty of emergency water.

LPA of Haley observed a pile of clutter in the backyard on the side of the house. The clutter observed consist of various items: wood debris, metals, and poles. LPA Haley advised AD Conanan the importance of keeping the facility free and clear of clutter and debris at all times. An LIC 9102 Advisory Notes: Technical Violation was issued for the clutter and debris observed.

No bodies of water were observed during today's visit. All smoke detectors were tested and are operational.

No deficiencies are being cited during todays visit. An exit interview was conducted and a copy of this report and LIC 9102 was provided to Administrator Conanan.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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