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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000873
Report Date: 11/18/2024
Date Signed: 11/18/2024 11:27:36 AM

Document Has Been Signed on 11/18/2024 11:27 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:BATES FAMILY HOME IIIFACILITY NUMBER:
306000873
ADMINISTRATOR/
DIRECTOR:		RANDALL & SANDRA BATESFACILITY TYPE:
735
ADDRESS:26631 ESTRADA CIRCLETELEPHONE:
(949) 458-9315
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 4DATE:
11/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Randall BatesTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analysts (LPAs) Ruth Martinez and Nancy Guillen are conducting this unannounced visit for the purpose of completing an annual required inspection. LPAs arrived at the facility and were greeted and granted entry by staff and LPAs explained the nature of the visit. Randall Bates, Administrator arrived shortly after and met with LPAs.

Four clients reside at this facility, LPAs were informed clients were out in the community. LPAs began the tour of the inside and outside of the facility. LPAs observed required department postings posted on the wall of facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishable foods and two days of perishable foods available. There is additional food storage located in the garage. The facility is maintained at a comfortable temperature. LPAs inspected that medication is centrally stored in a safe locked storage cabinet located in the dining room. LPAs reviewed medication and observed medication was labeled and stored inaccessible to clients in care. LPAs inspected the bathrooms and LPAs measured the hot water temperature which measured 114.2 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPAs observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in a kitchen cabinet and additional supplies also locked in a garage cabinet. The facility has an available clean supply of linens. LPAs inspected client’s bedrooms which have sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for clients in their bedroom. Smoke detectors were tested and found to be operational. LPAs toured the outside of the facility and observed outdoor passageways are free of obstructions. LPAs observed there is shaded seating areas for client’s enjoyment. LPAs observed two fire extinguishers with a service date of September 6th, 2024 in kitchen and dining room. The LPAs verified the last fire drill was conducted on

Continued on LIC809-C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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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: BATES FAMILY HOME III
FACILITY NUMBER: 306000873
VISIT DATE: 11/18/2024
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October 18th, 2024, and are conducted quarterly. LPAs began review of records. LPAs reviewed two clients’ records. All the required documentation were present and current in client’s files reviewed. Four of the facilities P&I records were reviewed. LPAs observed that an individual log is maintained for each client. All monies are accounted for and attached receipts for record keeping. LPAs reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility. LPAs observed records reviewed have a current First Aid certificate.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected 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.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC809 (FAS) - (06/04)
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