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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000259
Report Date: 10/04/2024
Date Signed: 10/04/2024 04:01:53 PM

Document Has Been Signed on 10/04/2024 04:01 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:PACIFIC PLACE GUEST HOMEFACILITY NUMBER:
306000259
ADMINISTRATOR/
DIRECTOR:		L. GARCIANOFACILITY TYPE:
735
ADDRESS:1584 PACIFIC PLACETELEPHONE:
(714) 776-8130
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 4DATE:
10/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Ligaya GarcianoTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting the required one-year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Staff contacted Licensee/Administrator (AD) Ligaya Garciano via telephone who arrived and was present for the remainder of the visit. AD Garciano has a current Administrators certificate that expires March 30, 2025.

Pacific Place Guest Home is a one-story community with four bedrooms and two bathrooms.
The current capacity is 6 and the census was 4 during today’s visit.

During the inspection, LPA Haley observed all client bedrooms. The bedrooms had all the requirements and were in compliance with regulation guidelines. A supply of hygiene items was observed in the hallway closet. In a hallway locked closet closest to the front door, is additional hygiene items, paperwork and client P&I funds.

A fire extinguisher was observed fully charged and mounted on the walls in the dining room. A Carbon monoxide detector was observed on the wall in the hallway and tested operational.

Hot water measured at 111 degrees Fahrenheit. No hazardous items were observed in the resident bathrooms. Grab bars were tightly secured to the walls.

The kitchen was clean and organized. LPA observed a perishable and nonperishable food supply in compliance with regulation guidelines. Knives and sharp objects are kept locked in a cabinet with client medications, and a backup first aid kit. The stove was clean and in good working order.

Continued on LIC809C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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: PACIFIC PLACE GUEST HOME
FACILITY NUMBER: 306000259
VISIT DATE: 10/04/2024
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There’s a small office area in the living room with a computer. Client and resident files are kept locked in cabinets. The fireplace has a screen covering and the TV stand in front of the fireplace.

The garage is used to store additional items. LPA observed incontinent care supplies, non-perishable food items, and additional food supply in the refrigerator. A dresser, mattresses, and a washer and dryer was observed in the locked garage.

The backyard was clean, organized, and walkways were free of obstruction. During the tour of the exterior portion a shaded patio area with a table and chairs was observed. The side exit gate is self-latching.

Smoke detectors were observed in all client rooms, the living room, and hallways. During the inspection all smoke detectors tested operational.

The last emergency drill was conducted September 2024, and are conducted monthly for staff on each shift.

During the inspection, 4 client files were reviewed, 4 client medications were reviewed, 4 client P&I funds were counted, 3 staff files were reviewed, and 4 clients were interviewed.

No deficiencies are being cited as a result of todays visit.

An exit interview conducted, and a copy of this report was provided to AD Ligaya Garciano

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024
LIC809 (FAS) - (06/04)
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