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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001397
Report Date: 08/30/2022
Date Signed: 08/30/2022 01:54:27 PM

Document Has Been Signed on 08/30/2022 01:54 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:JONATHAN'S HOMEFACILITY NUMBER:
306001397
ADMINISTRATOR:PRISCILLA S. BUSTAMANTEFACILITY TYPE:
735
ADDRESS:1519 SHELTON STTELEPHONE:
(714) 754-7184
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 6CENSUS: 2DATE:
08/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:47 PM
MET WITH:Patricia Festin, AdministratorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by caregiver and LPA explained the nature of the visit. Patricia Festin, Administrator arrived shortly after and met with LPA.

LPA Martinez began the tour of the inside and outside of the facility. There are two clients in care and there are no active covid-19 cases in facility. LPA observed a check in station in the main entry of the facility. Facility is taking temperature daily and documenting the results. LPA observed required department postings, covid-19 precautionary postings in the facility as well as hand washing signs throughout the facility. LPA observed the emergency disaster and evacuation plan. All restrooms observed to have ample supply of soap and appeared to be clean. LPA inspected clients’ bedrooms and appeared to be clean and sanitary. All bedrooms observed to have all required components. Facility has the back-up emergency food and water supply. Facility has PPE supply located in the main entry in the check in station area. LPA observed the supply of medication. LPA toured the outside of the facility and observed a seating area for client’s enjoyment.

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: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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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