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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002664
Report Date: 04/04/2022
Date Signed: 04/04/2022 04:58:17 PM


Document Has Been Signed on 04/04/2022 04:58 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:WHISPERING OAKS - RANCHGROVEFACILITY NUMBER:
306002664
ADMINISTRATOR:IMELDA CAROFACILITY TYPE:
740
ADDRESS:4531 RANCHGROVE DRIVETELEPHONE:
(714) 931-1945
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:6CENSUS: 2DATE:
04/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Imelda CaraTIME COMPLETED:
05:15 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. . LPA met with Administrator Imelda Cara. Administrator's certificate expires 12/20/2022. LPA and Administrator toured the facility. Facility has 4 bedrooms, 2 bathrooms, living room, dining room, kitchen and a 2 car garage. LPA observed the fireplace in the living room is not screened. LPA observed all bedrooms had the required furnishings. Both bathrooms were clean and operational. Hot water measured 115 degrees Fahrenheit in bathroom one and 116.9 degrees Fahrenheit in bathroom 2. LPA and Administrator toured the garage. The garage contains the washer and dryer and is used for storage. LPA observed a two day perishable and seven day non-perishable food supply on hand in the kitchen. Medication is kept locked in a kitchen cabinet. LPA observed the knives are kept locked in a kitchen drawer. LPA observed the first aid kit is kept with the medications. LPA and Administrator toured the backyard. No bodies of water observed. LPA observed a covered patio with a seating area for residents. LPA observed the exit gate is latched and operational. No obstacles or hazards observed in the backyard. LPA observed the fire extinguisher in the kitchen is fully charged. Smoke detectors and the carbon monoxide detector tested operational. LPA observed the sliding screen door from bedroom 4 has been removed and is in the backyard. LPA observed the See Something, Say Something Poster (PUB 475) is posted in the hallway away from the entrance and is 8 1/2 by 11 inches. Facility has a mitigation plan that is pending approval. No Deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2022
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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