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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001302
Report Date: 07/22/2024
Date Signed: 07/22/2024 12:40:54 PM


Document Has Been Signed on 07/22/2024 12:40 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:CONRAD'S GUEST HOMEFACILITY NUMBER:
306001302
ADMINISTRATOR:GO, MARIAFACILITY TYPE:
740
ADDRESS:511 N. DEXTERTELEPHONE:
(562) 266-8425
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:6CENSUS: 1DATE:
07/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee, Maria GoTIME COMPLETED:
12:45 PM
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On 7/22/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Licensee, Maria Go who informed of the purpose of LPA's visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents and an approved hospice waiver for three (3).

LPA toured the facility with Licensee and observed the facility is made up of a one-story home with three (3) resident bedrooms, two (2) bathrooms, two (2) staff rooms, a kitchen, dining room and attached garage. During LPA's visit, the current resident residing in the facility was sleeping. Therefore, LPA did not request for Licensee to test the smoke alarms/carbon monoxide detectors. LPA reviewed the facility's "Monthly Fire Drill/Alarm & Smoke Detector Test Record - Yearly" noting the smoke alarms/carbon monoxide detectors were tested by the local fire department on 11/8/2023. LPA also observed a charged fire extinguisher mounted in the kitchen, which was serviced on 6/22/2024. Indoor and outdoor passageways were free of obstruction. The facility has outdoor shaded seating for the resident in care. No bodies of water were observed on the premises. Medications are secured in a locked dining room cabinet. LPA reviewed the current resident's medication administration record along with their physical medications and did not discover any discrepancies. LPA also reviewed the resident's file, which obtained the Department's required records. Resident bedrooms had the required furniture and lighting. Bathrooms had grab bars near the toilet and in the shower. LPA toured the kitchen and observed the facility had more than a 2-day supply of perishable foods and 7-day supply of non-perishable food items.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted where this report was reviewed and provided to Licensee.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: 951-248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024
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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