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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000341
Report Date: 04/02/2024
Date Signed: 04/02/2024 12:19:17 PM

Document Has Been Signed on 04/02/2024 12:19 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:W & E FAMILY HOMEFACILITY NUMBER:
306000341
ADMINISTRATOR:MARITES T. DE VERAFACILITY TYPE:
735
ADDRESS:25242 TURF AVENUETELEPHONE:
(949) 597-9166
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 2DATE:
04/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Marites T. De Vera- Licensee/AdminstratorTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose to conduct the Required 1 Year Annual Inspection. LPA was greeted by Care Staff (CS) Magrace Arguelles and was granted entry. Licensee/Administrator Marites T. De Vera arrived on premise shortly after and was advised of the visit.

This is a single story, Level 2 facility comprised of three client bedrooms, one client bathroom, one staff bedroom/private bathroom, living room, dining area/kitchen, and an attached laundry room and a two-car garage. During today's visit, there were no clients present and one staff on duty. LPA toured inside the facility. LPA observed the client bedrooms had all the required elements with ample lighting. The shower, faucet, and toilet were clean and sanitary. The hot water temperature measured at 111.9 degrees Fahrenheit in the client bathroom. There were sufficient and clean supply of linens. LPA observed ample two-day supply of perishables and seven-day supply of non-perishables. LPA observed five cans of expired food. LPA observed the emergency food and water supplies. The carbon monoxide and smoke detectors were tested and operational. The fire extinguisher was mounted, charged, and serviced on March 28, 2024. Medications, toxins, and sharps were locked and inaccessible to the clients. LPA toured the outside grounds. The exit gate was self-closing and self-latching. There was sufficient shading and seating for the clients. The following items were reviewed: Emergency Disaster Plan (LIC610D), food menu, activities, and the client's rights. LPA reviewed two out of two client files, medications, and P&I funds. No discrepancies noted. LPA also reviewed two out of the two staff files and conducted interviews with the two staff. No discrepancies noted.
Licensee was advised on the following: to maintain the quality and integrity of the food and to ensure the canned food is not expired. Based on today's observations, no deficiency is being cited as per the Title 22 Division 6 Chapter 1 of the California Code of Regulations. A Technical Advisory is being issued. An exit interview was conducted with Licensee/Administrator Marites T. De Vera, and a copy of this report including the Technical Advisory were provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024
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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