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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002361
Report Date: 02/10/2023
Date Signed: 02/10/2023 12:20:09 PM

Document Has Been Signed on 02/10/2023 12:20 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:PUNZALAN HOMES INCFACILITY NUMBER:
306002361
ADMINISTRATOR:ED & LINDA PUNZALANFACILITY TYPE:
735
ADDRESS:2655 W. ROME AVENUETELEPHONE:
(714) 821-5677
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 6DATE:
02/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Linda PunzalanTIME COMPLETED:
12:25 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
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. LPA met with Linda Punzalan, Administrator and explained the nature of the visit.

LPA accompanied by Administrator began the tour of the inside and outside of the facility. There are six clients in care and no active covid cases in the facility. LPA was informed three clients were out in the community and three clients were in the facility. There is a sign-in procedure in place, and LPA was checked in with temperature check. LPA observed required department postings, covid precautionary postings and hand washing sign throughout the facility. The facility has an approved mitigation plan in place with CCLD. Facility has required Emergency Disaster Plan posted at the facility. Facility has a locked secured location in the kitchen for client’s medication. LPA observed there was a 30 day supply of medication for clients. LPA toured the kitchen and observed there is a one week of non-perishable foods and two days of perishables foods available. Facility has an emergency food and water supply in attached garage storage. The facility has a supply of hygiene, cleaning and disinfecting products. Personal protective equipment (PPE) supply is stored in attached garage. Bathroom were observed to have a supply of soap, toilet paper and hand towels. LPA toured the client’s bedrooms, all bedrooms are private with one client per. All bedrooms observed to have all required components. LPA toured the outside of the facility and observed there is a covered patio that provides shade for client’s use.

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)
Page: 1 of 1