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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000870
Report Date: 03/17/2023
Date Signed: 03/17/2023 11:15:09 AM

Document Has Been Signed on 03/17/2023 11:15 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:QUAIL HOMEFACILITY NUMBER:
306000870
ADMINISTRATOR:RAFAEL A. TORRESFACILITY TYPE:
735
ADDRESS:128 N. QUAIL LANETELEPHONE:
(714) 639-6947
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY: 6CENSUS: 4DATE:
03/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Elizabeth Pilien-Caregiver, Rafael Torres-AdministratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an unannounced Health and Safety visit in conjunction with complaint visit 22-AS-20230316145326. LPA Ramirez was allowed entry into the facility and initially met with Staff 1 (S1) Elizabeth Pilien and explained the purpose of the visit. Administrator (AD) Rafael Torres arrived shortly after.

During the inspection, LPA toured the facility with S1. LPA observed there were two staff present, all wearing
PPE. LPA observed three clients present. LPA conducted Health and Safety checks on the three clients present and confirmed they were doing well and observed no Health and Safety issues. LPA observed the facility to be clean and organized and found no Health and Safety issues. LPA observed the facility has a two-day supply of perishables and a seven-day supply of non-perishable food is available as required by regulations. LPA observed the electricity and water were running and the facility had soap and paper towels. At 9:09 AM LPA observed that two of two restrooms do not have a wash your hands sign. LPA confirmed all staff are background cleared. LPA requested copies of the client roster and staff roster. LPA verified facility has a current administrator with the certificate expiring on 04/23/2024.

Facility representative was advised that at this time further investigation may be required. An exit interview was conducted with AD Torres and a copy of this report was provided at the time of exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2023
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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