<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002309
Report Date: 05/05/2022
Date Signed: 05/05/2022 02:24:47 PM


Document Has Been Signed on 05/05/2022 02:24 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:EUROPEAN LOVING CARE IFACILITY NUMBER:
306002309
ADMINISTRATOR:COTILIA DAHABREHFACILITY TYPE:
740
ADDRESS:6561 DOHRN CIRCLETELEPHONE:
(714) 848-5544
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
05/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Administrator, Cotilia DahabrehTIME COMPLETED:
02:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On this day Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and was granted entry into the facility by Staff. LPA explained the reason for the visit.

At 1:15 PM LPA toured the facility with Staff. Facility is a 7 bedroom (6 resident rooms and 1 staff room) and 4 bathroom single story home. There are 6 Residents in care. LPA observed proper Covid signage at front entrance of facility. LPA observed facility has required Department postings visible to the public and residents. LPA observed copy of Administrators certificate expiring 01/27/23. Facility has required mitigation plan and Emergency Disaster Plan posted. Upon entry of facility a guest sign in station with hand sanitizer was accessible. LPA toured all resident rooms, rooms appeared clean, sanitary and where within regulations. All restrooms observed contained a working water basin, soap, hand sanitizer, wipes gloves, toilet paper and paper towels. Restrooms had proper hand washing signs posted. Residents were observed relaxing in bedrooms and sitting in common area living room. Facility has operating smoke detectors and carbon monoxide detectors.

Facility has PPE supply. Facility has 2 refrigerators and pantry with ample food supply. Facility has two day supply of perishable and seven day supply of non- perishable foods available as required by regulations. LPA observed facility has ample emergency food and water supply. Facility has 1 fire extinguisher which is fully charged. Facility has evacuation plan posted. Facility has a secured location for Resident medication and files. Facility has 30 days supply of medications for Residents. LPA reviewed 6 of 6 Residents files during visit. Residents emergency contact information and physicians reports are current. Facility has two designated outside visitation areas with ample shade.

No deficiencies noted during today’s visit. An exit interview was conducted with Licensee and copy of this report was left at facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1