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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306002525
Report Date:
09/29/2021
Date Signed:
09/29/2021 12:53:54 PM
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:
NEW ERA GUEST HOME II
FACILITY NUMBER:
306002525
ADMINISTRATOR:
JOSEFINA GUTIERREZ
FACILITY TYPE:
740
ADDRESS:
9831 ROYAL PALM BLVD.
TELEPHONE:
(714) 583-8643
CITY:
GARDEN GROVE
STATE:
CA
ZIP CODE:
92841
CAPACITY:
6
CENSUS:
6
DATE:
09/29/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Josefina Gutierrez
TIME COMPLETED:
01:11 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Administrator Josefina Gutierrez arrived at 11:10 am. LPA and Administrator toured the facility. Facility has 7 bedrooms and 4 bathrooms. All residents have private bedrooms. All resident bedrooms had the required furnishings and were clean and organized. All 4 bathrooms were clean and operational. LPA inspected the kitchen. The kitchen was clean and organized. LPA observed 2 day perishable and 7 day non-perishable food on hand. Smoke detectors/carbon monoxide detectors tested operational. LPA and Administrator toured the garage. The garage is kept locked and used for storage. LPA and Administrator toured the backyard. LPA observed a shed in the backyard. The shed is kept secured and used for storage. No bodies of water observed. Both exit pathways leading to the front of the house are free from obstacles and hazards. Both exit gates are operational. LPA did not observe any obstacles or hazards inside or outside of the facility. Facility mitigation plan is pending approval. No deficiencies are being cited as a result of this visit. An exit interview was conducted with the Administrator and a copy of the report provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/29/2021
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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