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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001215
Report Date: 09/16/2024
Date Signed: 09/16/2024 04:45:41 PM

Document Has Been Signed on 09/16/2024 04:45 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:ELIZABETH HOMES/SAN RICARDOFACILITY NUMBER:
306001215
ADMINISTRATOR/
DIRECTOR:
SANTOS, ELIZABETHFACILITY TYPE:
735
ADDRESS:6303 SAN RICARDO WAYTELEPHONE:
(714) 995-1106
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 4DATE:
09/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Maxine Kniazeff & Shirley KniazeffTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. Administrators (AD) Shirley Kniazeff and Maxima Kniazeff arrived and was present for the visit.

During the inspection, LPA Haley observed all client bedrooms and bathrooms. All client bedrooms had the necessary elements and were in compliance with regulation guidelines. There is a closet/storage space with emergency bags prepared for each client, and a supply of emergency water right across from the front door.

Client bathrooms were clean and organized. Hot water temperatures were measured in the range of 106.7 degrees Fahrenheit and 108.1 degrees Fahrenheit. No hazardous items were observed in the client bathrooms, and all grab bars were tightly secured to the wall.

In the kitchen knives and sharp objects are kept locked in a cabinet near the stove. Hazardous cleaning materials are kept locked under the sink. A perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the cabinets. There’s an emergency supply of food stored in a dining room cabinet.

There’s a laundry area equipped with a washer and dryer next to the kitchen.

The garage was organized, free of clutter and used as a storage space. Miscellaneous items were observed including, DVDs, clothing items, a bike, gloves and other facility items. The garage area remains locked and inaccessible to clients at all times. An additional refrigerator with an additional supply of food items was observed in the garage.

Client medications, medication books, a first aid kit, and Client P&I funds are locked in a cabinets near the dining room.

Continued on LIC809C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ELIZABETH HOMES/SAN RICARDO
FACILITY NUMBER: 306001215
VISIT DATE: 09/16/2024
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The backyard was clean, organized, and walkways were free of obstruction. A shaded patio area with tables and chairs was observed. Side exit gates are self-closing and self-latching.

Smoke detectors, and the carbon monoxide detector tested operational. Two fully charged fire extinguisher was observed. One mounted on the wall in the kitchen above the sink, and a second extinguisher mounted on the wall near bedroom 5.

Emergency evacuation drills are conducted on the 5th of each month and will continue to be conducted at least quarterly for staff on each shift.

No deficiencies are being cited as a result of today’s visit.

An exit interview conducted, and a copy of this report was provided to Administrator Maxine Kniazeff.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC809 (FAS) - (06/04)
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