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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001577
Report Date: 03/02/2022
Date Signed: 03/03/2022 02:34:43 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/03/2022 02:34 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:RIDGE GATE HAVENFACILITY NUMBER:
306001577
ADMINISTRATOR:JULITO MADRIGALFACILITY TYPE:
740
ADDRESS:4447 RIDGE GATE ROADTELEPHONE:
(714) 998-7803
CITY:ANAHEIM HILLSSTATE: CAZIP CODE:
92807
CAPACITY:6CENSUS: 0DATE:
03/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Zenaida Madrigal & Julito MadrigalTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michelle Reed made an unannounced visit to the facility to conduct an Annual visit. Upon arrival LPA met with Staff Zenaida and Julito Madrigal. The focus of the visit was Infection Control. Licensee Renato Madrigal was contacted and a message left of LPA's visit. Renato arrived at approximately 2:30pm. The facility was toured with Ms. Madrigal and the following was observed:

The Licensee is currently not operating. There were no clients present. Regional Center has not placed clients in the facility since March of 2021. LPA's temperature was taken upon arrival by Julito Madrigal. Restrooms observed contained soap, paper towels and toilet paper. Hand sanitizer, soap, wipes and gloves were present and in sufficient supply. The Licensee has at least a 30 day supply of PPE. LPA observed an outside visitation area with ample shading. Licensee has required Mitigation plan and Emergency Disaster Plan. Facility has emergency food and water supply. Facility has a secured medication cupboard for resident medication and files.

During the visit, LPA consulted with staff regarding the importance of maintaining a 30 day supply of PPE on site. Additionally, LPA advised the importance of mask wearing and hand washing for staff, visitors and residents. Administrator is reminded to review Department PINS in regards to Masking, Staff and Resident Testing, Visitation, Dining, Group Activities, Non-essential services, Outings, New Admissions and Entertainment.
No deficiencies noted during visit. An exit interview was conducted and a copy of this report was given to Renato Madrigal. Julito Madrigal and Renato Madrigal were reminded that the home must be in compliance when new residents are admitted and Licensing shall be notified.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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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