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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002492
Report Date: 06/19/2024
Date Signed: 06/19/2024 05:14:09 PM

Document Has Been Signed on 06/19/2024 05:14 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ELIZABETH HOMES- LOS MOLINOSFACILITY NUMBER:
306002492
ADMINISTRATOR/
DIRECTOR:
ELIZABETH SANTOSFACILITY TYPE:
735
ADDRESS:5940 LOS MOLINOS DRIVETELEPHONE:
(714) 995-1106
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
06/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Shirley KniazeffTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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Licensing Program Analysts (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Staff contacted Administrator Shirley Kniazeff who arrived a short time later and was present for the remainder of the of the visit.

During the inspection, LPA Haley observed all client bedrooms and bathrooms. All client bedrooms had the necessary elements and were in compliance with regulation guidelines.

Client bathrooms were clean and organized. Hot water temperatures were measured in the range of 116.2 degrees Fahrenheit and 118.2 degrees Fahrenheit. No hazardous items were observed in the client bathrooms, and all grab bars were tightly secured to the wall.

In the kitchen knives and sharp objects are kept locked under the sink. Hazardous cleaning materials are kept locked under the sink and separated from the sharp objects. A perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in a cabinet. There’s a locked pantry/cabinet space next to the garage with a supply of emergency supplies including, food, water, disaster bags, linen and other emergency items.

The garage was organized and free of clutter. There’s a washer and dryer in the garage, a large supply of adult diapers stocked on the shelves and other miscellaneous facility items stored in the garage area. There’s an additional refrigerator used to store staff food items.

The backyard was clean, organized, and walkways were free of obstruction. A shaded patio area with a table and chairs was observed. Under the shaded patio area are a few exercise machines, including an exercise bike for the clients to use.

Continued on LIC809C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ELIZABETH HOMES- LOS MOLINOS
FACILITY NUMBER: 306002492
VISIT DATE: 06/19/2024
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Smoke detectors, and the carbon monoxide detector tested operational. A fully charged fire extinguisher was observed in the kitchen.

An emergency evacuation drill was conducted June 5, 2024 and will continue to be conducted monthley for staff on each shift.

No deficiencies are being cited as a result of today’s visit.

An exit interview conducted, and a copy of this report was provided to Administrator Shirley Kniazeff.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC809 (FAS) - (06/04)
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