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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000873
Report Date: 11/03/2022
Date Signed: 11/03/2022 04:21:10 PM

Document Has Been Signed on 11/03/2022 04:21 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:BATES FAMILY HOME IIIFACILITY NUMBER:
306000873
ADMINISTRATOR:RANDALL & SANDRA BATESFACILITY TYPE:
735
ADDRESS:26631 ESTRADA CIRCLETELEPHONE:
(949) 458-9315
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 4DATE:
11/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Shirley F. BatesTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA and staff toured the facility. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the medication is kept locked in a cabinet. LPA observed sharp objects are kept locked in the kitchen. LPA observed all resident rooms had the required furnishings. LPA observed both bathrooms are clean and operational. Hot water measured 109.4 degrees Fahrenheit. LPA observed the grab bars were secure. LPA observed the fireplace in the living room is screened. LPA and staff toured the backyard. No bodies of water observed. There is a patio with a seating area for clients to sit outside. LPA observed both exit gates are operational. No obstacles or hazards observed in the backyard. Smoke/carbon monoxide detectors tested operational. LPA inspected the first aid kit, it had all the required elements. LPA and staff toured the garage. The garage is used for storage. Cleaning supplies are kept secured in the garage inaccessible to clients. No obstacles or hazards observed inside or outside of the facility. LPA consulted with staff concerning continued Covid-19 mitigation procedures and reporting requirements. No deficiencies observed during the visit, no deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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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