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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002360
Report Date: 02/10/2023
Date Signed: 02/10/2023 10:28:24 AM

Document Has Been Signed on 02/10/2023 10:28 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
ORANGE & INLAND A/SC, 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:
02/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Linda PunzalanTIME COMPLETED:
10:35 AM
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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 care staff and explained the nature of the visit. Linda Punzalan, Administrator arrived shortly after and met with LPA.

LPA accompanied by Administrator began the tour of the physical plan of the facility. There are six clients in care and no active covid cases in the facility. During the time of visit two clients were out in the community. LPA observed one client in the living room. There is a sign-in procedure in place and hand sanitize for use. There is a minimum of one week of non-perishable foods and two days of perishables foods available. Facility has an emergency food and water supply. Personal protective equipment (PPE) supply was observed in the garage storage. Facility is equipped with hygiene, cleaning and disinfecting supplies. LPA inspected medication, facility has a secure locked location for client’s medication, and it was observed there was a 30 day supply of medication for clients. LPA observed required department postings, covid precautionary postings and hand washing signs posted throughout the facility. The facility has a Mitigation Plan on file with the department. The Emergency Disaster Plan was observed to be posted. All facility bathrooms were observed to be clean and to have a supply of soap. LPA toured the client’s bedrooms, all bedrooms observed to have all required components. Clients were observed in their bedrooms. LPA toured the outside of the facility and observed a covered patio 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 the 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: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2023
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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