<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001360
Report Date: 10/16/2024
Date Signed: 10/16/2024 03:00:18 PM

Document Has Been Signed on 10/16/2024 03:00 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:BUBBE & ZAYDE'S PLACE IIIFACILITY NUMBER:
306001360
ADMINISTRATOR/
DIRECTOR:
BONNIE CURKINFACILITY TYPE:
740
ADDRESS:1530 E. 21ST STREETTELEPHONE:
(714) 543-3939
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 3DATE:
10/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Shimon CaganTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Lydia Martinez and Samer Haddadin conducted an unannounced visit for the purpose of completing an Required 1 Year inspection. LPAs were greeted and granted entry by Caregiver Anna Vazquez and later joined by Administrator Shimon Cagan.

The facility is a single-level structure and licensed for six non-ambulatory with a hospice waiver for four. This facility is a Residential Care Facility for the Elderly.

LPAs toured the interior and exterior portions of the facility. There were 3 residents rooms. Resident rooms were provided with furniture, chair, clean linen, adequate storage space, and kept free of tripping hazards. Hard wired smoke detectors, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair and provided with grab bars and hot water was measured at 110.6 degrees Fahrenheit. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements.

Fire extinguisher was observed with last inspection date of 03/12/24 . For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards and ample space for activities. Facility has a 2-car garage and is kept locked and used for storage. Laundry room was equipped with an operational washer and dryer.

LPAs observed kitchen cabinets were getting a make-over during this visit. Otherwise kitchen was in good repair with cleaning supplies and sharp items inaccessible to residents in care. Medications are kept locked separately in a closet hallway. LPAs reviewed two clients’ files and no medication discrepancies were observed. LPAs reviewed two staff files with no discrepancies. All files of staff and clients contained all required documentation.


Conti LIC809C.....
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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: BUBBE & ZAYDE'S PLACE III
FACILITY NUMBER: 306001360
VISIT DATE: 10/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Upon review of records, the facility is up to date with required quarterly fire drill, which was last conducted on September 9th, 2024. LPAs also checked The administrator certificate which is valid and expires on November 21, 2025.

No deficiencies were noted during today's inspection visit. An exit interview was conducted, and a copy of this report was provided to the Administrator.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2