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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002360
Report Date: 03/01/2022
Date Signed: 03/01/2022 10:24:01 AM

Document Has Been Signed on 03/01/2022 10:24 AM - 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:PUNZALAN HOMEFACILITY NUMBER:
306002360
ADMINISTRATOR:ED & LINDA PUNZALANFACILITY TYPE:
735
ADDRESS:1627 W. CATHERINE DRIVETELEPHONE:
(714) 535-2407
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 6DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Linda PunzalanTIME COMPLETED:
10:32 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was screened for symptoms of Covid-19 and granted entry. LPA met with Administrator Linda Punzalan. LPA and Administrator toured the facility. Facility has 6 bedrooms, each client has their own room. Smoke detectors/carbon monoxide detectors tested operational. LPA observed all of the client bedrooms were clean and organized. All 3 bathrooms were clean and operational. LPA observed chipped paint in bathroom number one. Hot water temperature measured from 116.9 to 117.2 degrees Fahrenheit. LPA and Administrator toured the kitchen. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand. The kitchen is clean and organized. LPA observed the knives are kept locked in a cabinet. Medication is kept locked in a cabinet. The stove is operational and lights unassisted. LPA observed Covid-19 precautionary signs throughout the facility. The living room has a TV and sitting area for the clients. LPA observed a bookcase in the dining room which has games and puzzles for the clients. LPA observed the fire extinguisher in the den was fully charged. LPA and the Administrator toured the garage. The garage is used for storage and has a washer and dryer. There is a staff room in the garage. The garage is kept locked and inaccessible to clients. LPA inspected the first aid kit. The first aid kit had all the required elements. LPA and Administrator toured the backyard of the facility. LPA inspected the storage shed. The shed is kept locked and used for storage. No bodies of water observed. There is a table and chairs along with an exercise bike for clients. Both side exit gates are operational. No obstacles or hazards observed. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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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