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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001577
Report Date: 12/28/2023
Date Signed: 12/28/2023 12:00:58 PM


Document Has Been Signed on 12/28/2023 12:00 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 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:
12/28/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Julito Madrigal - AdministratorTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility for the purpose of conducting a Plan of Corrections follow up visit. LPA arrived and was greeted and granted entry by Owner, Zenaida Madrigal. LPA explained the purpose of the inspection. Administrator (AD) Julito Madrigal joined the inspection soon after LPA's arrival.

LPA observed the designated bedroom does not have the required furnishings and is still storing exercise equipment. A civil penalty is being assessed on this day.

LPA noted, via review of the Licensing Information System (LIS) the facility has not yet paid their annual fees or past due balance. A civil penalty is being assessed on this day.

LPA confirmed the AD completed First Aid/CPR training on 11/24/2023. LPA also observed facility has a fully charged fire extinguisher on the premises. The receipt attached to the extinguisher indicate that it was purchased on 01/19/2023.

Based on today's inspection, LPA determined that two of the deficiencies issued on 12/13/2023 have been corrected. LPA generated clear letters for these deficiencies. LPA determined that two of the deficiencies issued on 12/13/2023 have not been corrected. See LIC 809-D for remaining deficiencies. Two Civil Penalties are being issued. An exit interview was conducted and a copy of this report, clear letters, civil penalty assessments and appeal rights were provided.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2023
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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Document Has Been Signed on 12/28/2023 12:00 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: 12/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/29/2024
Section Cited
CCR
87307(a)(2)(B)

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(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 detached building. Based on LPA observations, the licensee did not comply with the section cited above as
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AD stated that the room would be converted back into a bedroom for resident use by the assigned POC due date of 1/29/2024. LPA will conduct a follow-up visit to confirm the correction.
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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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Type B
01/29/2024
Section Cited
CCR87156

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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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Administrator stated they will make the payment by assigned POC due date of 1/29/2024. Administrator stated they will send to LPA, via email, proof of payment of balance by the assigned POC due date of 1/29/2024.

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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: 12/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2023
LIC809 (FAS) - (06/04)
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