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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002286
Report Date: 11/22/2024
Date Signed: 11/22/2024 12:11:49 PM

Document Has Been Signed on 11/22/2024 12:11 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:R & R CARE, INC.FACILITY NUMBER:
306002286
ADMINISTRATOR/
DIRECTOR:
ROMAN MATAGAFACILITY TYPE:
740
ADDRESS:14952 BURNHAM CIRCLETELEPHONE:
(949) 651-1830
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 6CENSUS: 5DATE:
11/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Ma Kristina Adrindeda & Rachel Tutop, AdministratorsTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Nancy Guillen and Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPAs were greeted and granted entry by Staff #1. During today’s visit, LPA met with Ma Kristina Adrindeda & Rachel Tutop, Administrators.

The facility is a single story, five bedroom, three bathroom home with an approved fire clearance of six non-ambulatory residents of which two may be on hospice. The facility currently has a census of five residents in care.

During today’s visit, LPAs toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperatures in three of three resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 114.2 and 120.3 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational. The fire extinguisher is charged and was serviced on September 12, 2024. The facility’s last fire drill was conducted on June 1, 2024. LPAs inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPAs noted sharps and knives were secured, all appliances were in working order and medication cart is secured. LPAs observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid kits had all the required elements and the facility is ordering a current First Aid Manual.

LPAs toured the exterior and noted there was a shaded seating area in the patio, both exterior gates self-latched and closed, there were no hazards or obstacles in pathways and there was a shed used for storage.

(Continued on LIC 809)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: R & R CARE, INC.
FACILITY NUMBER: 306002286
VISIT DATE: 11/22/2024
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(Continued from LIC 809)

LPAs reviewed four of four staff training and fingerprint records and conducted a complete review of resident records. LPAs interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPAs confirmed that Roman Mataga has an administrator certificate which is on the pending renewal list and will expire on January 29, 2026. Maria Kristina Camille R. Adrineda is the current administrator with a current administrator's certificate which expires on July 22, 2026.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Ma Kristina Adrindeda & Rachel Tutop, Administrators and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
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