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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000670
Report Date: 10/28/2021
Date Signed: 10/28/2021 01:19:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NOHL RANCH ELDERLY CAREFACILITY NUMBER:
306000670
ADMINISTRATOR:GABE CORCHESFACILITY TYPE:
740
ADDRESS:2112 E. VALLEY GLEN LANETELEPHONE:
(714) 921-1899
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY:6CENSUS: 3DATE:
10/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Mariana Corches, AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by caregiver. LPA met with Administrator and explained the nature of the visit.

LPA Martinez accompanied by Administrator began the tour of the inside and outside of the facility. There are three residents in care and there are no active covid-19 cases in the facility. LPA observed two residents in the dinning room and one resident in their bedroom. All residents appeared to be clean ad well taken care of. LPA upon entry observed a check in station. Facility is taking temperature daily and documenting the results. LPA observed required department postings and covid-19 precautionary postings in the facility. All bathrooms observed to have supply of soap and appeared to be clean. LPA inspected residents’ bedrooms and they appeared to be clean and sanitary. All bedrooms observed to have all required components. Residents bedrooms are four private bedrooms with one resident per and one shared room with two residents per. LPA observed the emergency disaster and evacuation plan. Facility has emergency food supply as well as PPE supply. LPA toured the outside of the facility and observed seating area for resident’s enjoyment. The facility has completed the LIC808 Mitigation plan. The plan was reviewed and approved by the Department on April 27, 2021.

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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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