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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002370
Report Date: 10/05/2023
Date Signed: 10/05/2023 02:00:08 PM

Document Has Been Signed on 10/05/2023 02:00 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 COUNTY ASC, 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: DATE:
10/05/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:52 PM
MET WITH:Marie Noel - AdministratorTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. made an unannounced visit to the facility for the purpose of conducting a Plan of Correction (POC) inspection to verify correction of citations issued during visit conducted on 8/31/2023. LPA arrived at facility was greeted at the door by Henriaetta Labrado, Direct Support Staff and granted entry. LPA explained the nature of the visit. Administrator (AD) Marie Noel joined the inspection at 1:10pm

LPA observed that three of the four residents were away at day program. One resident remained at the facility due to a podiatrist appointment scheduled for the afternoon.

At the previous inspection, LPA observed the following instances of the facility being in disrepair: 1. backyard screen door got stuck when trying to open it presenting a fire hazard, 2. stove was missing an igniter knob, 3. sink in bathroom 1 was loose, 4. fireplace screen was broken, 5. there was a storage area accessible to clients near the pool. This area had a rusted wagon and tricycle that presented hazards to clients. The staff cleared the pool area storage during the previous visit.


LPA also observed the hot water in bathroom 1 to measure at 128.4 degrees Fahrenheit

LPA toured the facility and observed the following:

1. backyard screen door is operational, 2. stove has all igniter knobs, 3. sink in bathroom 1 is operational, 4. fireplace screen is operational, 5. pool storage area remains free of hazardous objects.


LPA also observed the hot water in bathroom 1 to measure at 110.4 degrees Fahrenheit

Based on today's visit, it is determined that the facility has fulfilled their POC by the assigned due date. LPA generated letter of deficiency citations cleared and provided copy to facility. Exit interview conducted and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
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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