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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000470
Report Date: 11/15/2024
Date Signed: 11/15/2024 11:35:34 AM

Document Has Been Signed on 11/15/2024 11:35 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 COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GLO-RILYNN GUEST HOMEFACILITY NUMBER:
306000470
ADMINISTRATOR/
DIRECTOR:
JAMES WALLACEFACILITY TYPE:
740
ADDRESS:2143 E. ALTURATELEPHONE:
(714) 637-6754
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
11/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Emerlene Zarate TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Samer Haddadin made an unannounced required annual inspection at this facility. LPA was greeted and granted entry, where LPA met with Administrator Emerlene Zarate and stated the purpose of this visit.

The facility is a single-level structure and licensed for six non-ambulatory with a hospice waiver for four. This facility is a Residential Care Facility for the Elderly (RCFE). At the time of the visit there were five residents in which three out of the five on hospice care. LPA toured the interior and exterior portions of the facility. There were 6 resident rooms one of which was vacant. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 108.5-110.4 degrees Fahrenheit.

LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated July 22,2024. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to clients. Medication cabinet was observed to be locked.For the exterior portion, facility had outside furniture in good repair; grounds were free of tripping hazards and debris. The backyard contained a swimming pool with a locked fence surrounding the pool. Facility has a 2-car garage which is kept locked and used for storage, contained emergency supplies, an operational washer/dryer, freezer and refrigerator. Kitchen was in good repair with cleaning supplies and sharp items kept locked and made inaccessible to residents in care.LPA reviewed 5 residents' files and observed they had all required documentation LPA reviewed Medications log and observed they were kept locked in a cabinet near the kitchen and inaccessible to residents in care.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.

Alisa OrtizTELEPHONE: (714) 703-2855
Samer HaddadinTELEPHONE: (714) 790-2096
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)
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