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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002235
Report Date: 01/27/2023
Date Signed: 01/27/2023 12:27:53 PM

Document Has Been Signed on 01/27/2023 12:27 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CATHERINE'S HOMES, INC. (ROOSEVELT)FACILITY NUMBER:
306002235
ADMINISTRATOR:CATHERINE GONZALESFACILITY TYPE:
735
ADDRESS:500 S. ROOSEVELT AVENUETELEPHONE:
(714) 738-5278
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 6CENSUS: 5DATE:
01/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Michael San Diego, AdministratorTIME COMPLETED:
12:35 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 into the facility by caregiver and LPA explained the nature of the visit. Michael San Diego, Administrator arrived shortly after and met with LPA.

LPA Martinez accompanied by caregiver began the tour of the inside and outside of the facility. There are five clients in care and there are no active covid-19 cases in the facility. The following was observed at the facility: all clients were out of the facility and in the community. Facility was observed to be clean and sanitary. Upon entry LPA observed covid precautionary posting in the entrance and a sanitary station for hand washing in the outside of the entrance. There is a check in station in the main entrance of the facility with PPE supply. LPA observed required department posting, covid precautionary postings in the facility as well as hand washing signs. There was a two day supply of perishables and seven day supply of non-perishables foods available. Restrooms observe to have soap and appeared to be clean. Clients bedrooms were observed to have all required components and appeared to be clean and sanitary. Facility has an emergency disaster plan and mitigation plan in place. Facility has a back-up emergency food and water supply. The facility has PPE supply for staff and clients. LPA toured the outside of the facility and observed seating areas for client’s enjoyment.

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 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: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2023
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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