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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001577
Report Date: 10/13/2022
Date Signed: 10/13/2022 10:34:37 AM


Document Has Been Signed on 10/13/2022 10:34 AM - 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:
10/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Zenaida MadrigalTIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Edward Tapia made an unannounced visit to the facility to conduct an Annual inspection. Upon arrival LPA met with staff Zenaida Madrigal. The focus of the visit was Infection Control. LPA contacted Licensee Renato Madrigal and informed him of the visit. Licensee was unable to make the visit. LPA made Licensee aware of upcoming annual fees due at the end of the month, Licensee understood. The facility was toured with staff and the following was observed:

The Licensee is currently not operating. There were no resident present. Regional Center has not placed residents in the facility since March of 2021. LPA toured the interior and exterior portions of the facility. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Restrooms observed contained soap, paper towels and toilet paper. 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.

No deficiencies were noted during visit. Licensee was reminded that the home must be in compliance when new residents are admitted, and Licensing shall be notified. LPA Tapia conducted an exit interview with staff and copy of this report was explained and left at the facility.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward TapiaTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022
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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