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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002587
Report Date: 03/18/2025
Date Signed: 03/18/2025 02:33:39 PM

Document Has Been Signed on 03/18/2025 02:33 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:VILLA SANTIAGOFACILITY NUMBER:
306002587
ADMINISTRATOR/
DIRECTOR:		CONSUELO M. RODRIGUEZFACILITY TYPE:
735
ADDRESS:817 E. 20TH ST.TELEPHONE:
(714) 542-4126
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY: 6CENSUS: 4DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Connie RodriguezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Villa Santiago. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and met with Administrator Connie Rodriguez. Facility is licensed for 6 non-ambulatory clients and the facility currently has 4 clients. Connie Rodriguez has an Administrator Certificate expiring on 02/25/2026.

LPA Lyman along with Administrator Rodriguez toured the facility at 12:35 PM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of two client bedrooms, one client bathroom, two staff rooms, one shared hall bathroom, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 113 and 118.2 degrees F in all facility bathrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. Facility is clean and sanitary. First aid kit had all the required elements including tweezers, thermometer, and scissors. LPA observed a locked storage area for cleaning supplies under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for clients. LPA observed emergency food and water supply in the garage. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 11/18/2024. Facility provides activities in the form of outings in the community. Facility clients are independent and out in the community. LPA reviewed P & I money for clients. Funds on hand matched facility ledger. CONTINUED ON LIC 809C DATED 03/18/2025

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: VILLA SANTIAGO
FACILITY NUMBER: 306002587
VISIT DATE: 03/18/2025
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At 1:00 PM, LPA reviewed four client files and one staff file. Client files contained required documents including admission agreements, current physician reports and client appraisals. Staff files reviewed contained required documentation of training, health screen/TB, and criminal record clearance. At 1:40 PM, LPA reviewed medication storage and administration. Medications are stored in a locked closet and are audited monthly by staff. Medications are being administered per physician order.






Based on the observations made during today’s inspection, NO deficiencies are being cited. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
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