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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002370
Report Date: 10/11/2021
Date Signed: 06/06/2022 12:42:38 PM

Document Has Been Signed on 06/06/2022 12:42 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:CHARIS CHATEAU, INCFACILITY NUMBER:
306002370
ADMINISTRATOR:MARIE NOELFACILITY TYPE:
735
ADDRESS:10231 DEWEY DRIVETELEPHONE:
(714) 636-6595
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 5CENSUS: 4DATE:
10/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Administrator Marie NoelTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Shobhana Frank made an unannounced visit to the facility today to conduct
required 1 year inspection. During today’s visit, LPA met with Administrator Marie Noel and explain the
purpose of today's visit. LPA Frank toured the facility, which included: Living room, dining area, kitchen,
laundry room, 4 bedrooms and 2 bathroom, shaded area, indoor/outdoor activity areas, reviewed
medications; medication records, food service, clients and staff records.
The facility is a one story house which is Licensed for Adult Residents five ambulatory clients Ages 18 to 59
Years. Currently 4 clients are in care. Each resident bedroom is equipped with the proper furniture and linen
supplies
In addition, LPA Frank tested the hot water temperature, which measured 107.1 degrees F in resident
bathroom. Resident areas were noted to be a comfortable temperature.
Smoke detectors and carbon monoxide detectors were tested and found to be operational. The facility also has fire extinguisher that was mounted and charged. LPA Frank confirmed food supply: 2 day supply of
perishables and 7 day supply of non-perishable food is available for the number of residents present.
Hygiene supplies and supply of linen were observed in quantities for the number of residents in care.
Body of water on premises was secured. The ramp leading from a client room to the backyard has extensive rot which could lead to injury to client(s) in the event of a collapse.
LPA observed locked areas for toxins and hazardous items. Medication were observed locked in cabinet.
LPA observed COVID - visitation station equipped with hand sanitizer, thermometer, Gloves, visitors log,
COVID posters throughout the facility.
LPA observe the facility to be clean and in good repair. Physical Plant and Safety of Environment/Operational
Requirements.
LPA Frank reviewed : 1.) Designation of Administrative Responsibility (LIC308) 2.) Personnel Report
(LIC500); 3.) Emergency Disaster Plan (LIC610E); 4.) LIC 9020A Client Roster; LIC 808) Mitigation Plan;
Current Liability Insurance.
Based on the observations made during today’s visit, no deficiencies are being cited in area inspected.
This report was discussed with the facility representative and a copy was provided.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Shobhana Frank
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2021
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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