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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001789
Report Date: 01/12/2024
Date Signed: 01/12/2024 02:51:11 PM

Document Has Been Signed on 01/12/2024 02:51 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: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: 40DATE:
01/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator - Mindy AndrewsTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. 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 Mason accompanied by Administrator began the tour of the inside and outside the facility. There are 40 clients in care and LPA observed clients throughout the facility. The facility is made up of several buildings. Buildings include residences, the dining room, kitchen, laundry rooms, staff offices and more. LPA observed required department postings, covid precautionary postings and hand washing signs through the facility. Facility has hand sanitizer stations throughout the facility. LPA reviewed client files, medication, P&I and staff files. LPA toured random living quarters on the property and observed all to have all required components. Bathrooms observed to have a supply of soap, toilet paper and paper towels. Bathroom hot water measured between 105 and 120 degrees Fahrenheit. The facility is equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Sharps and chemicals are locked and inaccessible to clients. Sharps and chemicals are also stored separately. Facility has an emergency food and water supply. Facility has a secure location for client’s medication. LPA toured the outside of the facility and observed several shaded seating areas for client’s use. Facility holds daily meetings with the clients in a shaded area outside.

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: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2024
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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