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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001577
Report Date: 10/18/2023
Date Signed: 10/18/2023 02:27:52 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/18/2023 02:27 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 ASC, 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:
10/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:43 AM
MET WITH:Zenaida Madrigal - OwnerTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dwayne Mason Jr. conducted an unannounced visit for the purpose of conducting a required annual visit. At 11:35am LPA was greeted and granted entry into facility by Owner Zenaida Madrigal. Administrator, Lito Madrigal could not be reached.

The facility is a one-story home with three resident bedrooms, two resident bathrooms, two staff bedrooms, one staff bathroom, family room, kitchen, two dining rooms, backyard and garage. Owner notified LPA that they have had no clients in over a year due to renovations. Owner stated they have completed renovations and are already looking for clients to admit. Facility appears clean and sanitary. Two residents rooms had required elements. One resident room was converted into a fitness area when residents moved out. LPA stated the room needs to be ready for Residents. Upon record review, LPA observed all staff CPR certifications to be expired. LPA stated all staff needs to update their CPR training. LPA observed fire extinguishers were last serviced on 7/28/2021. LPA stated extinguishers must be serviced before residents are admitted to the facility. Based on Record Review, LPA observed fees have not been paid. LPA stated that licensing fees must still be paid even though there are no residents in care because the facility is still licensed. Four deficiencies are being issued. Hot water temperatures measured in the appropriate range. LPA observed toxins and chemicals to be locked, the pool to be fenced, exit gates to be unlocked and medication to have a designated locked cabinet. The backyard has four shaded seating areas.

Based on today's inspection, four deficiencies are being issued. An exit interview was conducted with owner Zenaida Madrigal and a copy of this report was provided.

SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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 3


Document Has Been Signed on 10/18/2023 02:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868


FACILITY NAME: RIDGE GATE HAVEN
FACILITY NUMBER: 306001577

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2023
Section Cited
CCR
87156

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(a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569. Based on record review, the licensee did not comply with the section cited above as the facility has a past due balance. This poses a potential risk to future persons in care.
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Owner stated that they will reach out to administrator and advise him to pay. Owner stated that Administrator will send to LPA via email proof of payment of balance by the assigned POC due date of 11/17/2023.
Type B
11/17/2023
Section Cited
CCR
87203

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All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. Based on observation, the licensee did not comply with the section cited above as the facility's fire extinguishers were last serviced on
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Owner stated that the facility will get the fire extinguishers serviced before the assigned POC due date of 11/17/2023. Owner stated the Administrator will notify LPA when extinguishers have been serviced. LPA stated they will return for a follow-up visit to confirm the extinguishers have been serviced.
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7/28/2021. This poses a potential safety risk to future persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 10/18/2023 02:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868


FACILITY NAME: RIDGE GATE HAVEN
FACILITY NUMBER: 306001577

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2023
Section Cited
CCR
87307(a)(2)(B)

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(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements:(B)No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway,unfinished attic, garage, storage area, shed or similar
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Owner stated that the room would be converted back into a bedroom for resident use by the assigned POC due date of 11/17/2023. Owner stated Administrator would contact LPA via email upon completion of POC by the assigned POC due date. LPA will conduct
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similar detached building. Based on LPA observations, the licensee did not comply with the section cited above as one bedroom designated for resident use has been converted into a fitness room. This poses a potential personal rights risk to future persons in care.
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a follow-up visit to confirm the correction.
Type B
11/17/2023
Section Cited
HSC1569.618(c)(3)

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(c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at
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Owner stated Administrator will have staff complete CPR certification by the assigned POC due date of 11/17/2023. Owner stated Administrator will notify LPA via email when the staff completes CPR training. LPA will verify correction during the follow-up visit.
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all times. This paragraph shall not be construed to require staff to provide CPR. Based on record review, the licensee did not comply with the section cited above as none of the staff have a current CPR certification. This poses a potential safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3