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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001789
Report Date: 01/30/2023
Date Signed: 01/30/2023 12:26:37 PM

Document Has Been Signed on 01/30/2023 12:26 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MOORE VILLAGEFACILITY NUMBER:
306001789
ADMINISTRATOR:MINDY ANDREWSFACILITY TYPE:
735
ADDRESS:403 N. SUSAN STREETTELEPHONE:
(714) 480-0025
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY: 42CENSUS: 42DATE:
01/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Mindy AndrewsTIME COMPLETED:
12:40 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 by staff. LPA met with Mindy Andrews, Administrator and explained the nature of the visit.

LPA Martinez accompanied by Administrator began the tour of the inside and outside the facility. There are 42 clients’ in care and LPA observed clients throughout the facility. There are no active covid case in the facility. LPA was check in through facilities sign-in procedure and temperature was checked. LPA observed the check-in process for clients when returning to the facility from being out in the community. LPA observed required department postings, covid precautionary postings and hand washing signs through the facility. Facility has hand sanitizer stations throughout the facility. The facility has an approved Mitigation Plan on file with CCLD. LPA toured random living quarters on the property and observes to have all required components. Bathrooms observed to have a supply of soap, toilet paper and paper towels. The facility is equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Facility has an emergency food and water supply. Personal protective equipment (PPE) supply is available at the facility. Facility has a secure location for client’s medication, and it was observed there was a 30 day supply of medication for clients. LPA toured the outside of the facility and observed several shaded seating areas for client’s use.

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: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023
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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