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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000560
Report Date: 07/10/2026
Date Signed: 07/10/2026 05:20:26 PM

Document Has Been Signed on 07/10/2026 05:20 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:GARDEN VILLAFACILITY NUMBER:
306000560
ADMINISTRATOR/
DIRECTOR:		MARILES BORJAFACILITY TYPE:
735
ADDRESS:13031-13061 WILSON STREETTELEPHONE:
(714) 537-1545
CITY:GARDEN GROVESTATE: CAZIP CODE:
92844
CAPACITY: 32CENSUS: 28DATE:
07/10/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Dennis Mendoza, Robert MagnoTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced Annual Required inspection. LPA Tea was greeted and granted entry by Direct Support Professional (DSP) staff and explained the purpose of the visit. The facility is licensed for 32 clients, of whom six may be non-ambulatory. There were 28 clients present during today's visit. Assistant Administrator (AA) Dennis Mendoza and Secretary (ST) Robert Magno arrived shortly to assist with the inspection.

LPA reviewed four client files and three staff files. All client and staff files contained the required documentation. The Administrator's Certificate is valid through April 3, 2027.

LPA Tea, accompanied by ST Magno, conducted a tour of the facility, including the physical plant, food service areas, and first aid supplies. The facility consists of four residential buildings. The South House accommodates five clients, the Main House accommodates 12 clients, the Back House accommodates three clients, and the Front House accommodates 10 clients. An additional building on the premises is used for food storage and serves as a recreational room for clients and staff.

The facility's fire alarm system is monitored by a third-party company and was last inspected on June 25, 2026. Resident bedrooms contained the required furniture, clean linens, and adequate closet and drawer space. Client bathrooms were inspected and found to be clean and in good repair. Toilets and faucets were operational, grab bars were securely installed, and showers were free of mold and mildew. Hot water temperatures measured between 100°F and 114.4°F. The Front House had the lowest water temperature.

(Continuation of annual report on LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: GARDEN VILLA
FACILITY NUMBER: 306000560
VISIT DATE: 07/10/2026
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LPA advised the facility to adjust the water heater to meet the Department's required temperature range. The maintenance technician corrected the water temperature while LPA was on site, bringing it into compliance.

Bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean, well maintained, and free of hazards. Hallways and exits were unobstructed. The first aid kit contained all required supplies

The kitchen was inspected. Perishable and non-perishable food supplies were adequate to meet client needs. LPA observed that sharps were secured in a locked kitchen cabinet and toxic substances were properly locked and inaccessible to clients. Fire extinguishers throughout the facility were fully charged. The most recent fire drill was conducted on May 25, 2026. Kitchen appliances were observed to be operational.

LPA inspected the outdoor grounds and observed ample seating and shaded areas for clients. Emergency food and water supplies were reviewed in the storage area. LPA observed that the facility's emergency water supply was insufficient to meet the required 72-hour emergency preparedness requirement for clients and staff and reminded the facility to obtain additional emergency drinking water. During the visit, LPA observed clients participating in a bingo activity in the Main House. Staff provide recreational games, outdoor activities, and periodic community outings for clients.

LPA reviewed medication storage and administration practices. Medications were stored in locked medication carts located in each residential building and were being administered in accordance with physician's orders. Personal and Incidental (P&I) funds were reviewed and found to be maintained in compliance with Department requirements. LPA interviewed clients regarding the quality of care and services provided and spoke with staff regarding client care.

Based on observations made during today's inspection, no deficiencies were cited in the areas inspected under Title 22, Division 6 of the California Code of Regulations.

An exit interview was conducted with the facility representative. A copy of this report LIC 809, LIC 809-C, LIC 858, LIC 859, and LIC 9102TV was reviewed and provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC809 (FAS) - (06/04)
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