<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000198
Report Date: 11/15/2024
Date Signed: 11/15/2024 03:54:11 PM

Document Has Been Signed on 11/15/2024 03:54 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:ORANGEWOOD VILLAFACILITY NUMBER:
306000198
ADMINISTRATOR/
DIRECTOR:		MANSUETO T. CONANAN JR.FACILITY TYPE:
735
ADDRESS:7801 ORANGEWOOD AVENUETELEPHONE:
(714) 897-8797
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY: 6CENSUS: 6DATE:
11/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Rema Conanan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Rose Ruppert and Fred Arias made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 12:10 PM. During today’s visit, LPAs met with Rema Conanan, Administrator (AD). At the time of the visit, five of six clients were attending Adult Day Program and one client remained at home due to not feeling well.

The facility is a level 3, single story building with an approved fire clearance of six ambulatory. The facility currently has a census of six clients in care. There are three shared client bedrooms and one bathroom. All client bedrooms had the required furnishings, mattress covers and linens.

During today’s visit, LPAs toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing the hot water temperature in one client bathroom. The hot water temperature measured 111.9 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on September 17, 2024. The facility’s last fire drill was conducted on November 10, 2024. LPAs inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPAs observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPAs observed a First Aid Kit with all the required elements and a First Aid Manual book.

LPAs toured the exterior and observed shaded seating areas and a storage unit on the property. There are two exit gates from the property and both gates were latched and closed. LPAs reviewed three of three staff training and fingerprint records and conducted a complete review of client records. Client P&I records were reviewed and were accurate. Facility has Regional Center Admissions Agreements on file and were advised to create Admissions Agreements that comply with Title 22 Regulations. LPAs interviewed two alert clients regarding their quality of care and spoke to staff present regarding care provided.
(Continued on LIC 809)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: ORANGEWOOD VILLA
FACILITY NUMBER: 306000198
VISIT DATE: 11/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Continued from LIC 809)

LPAs confirmed that administrator has a current administrator certificate which expires on March 30, 2025.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Rema Conanan, Administrator and a copy of the report, LIC 9102-TV and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3