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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002874
Report Date: 10/19/2022
Date Signed: 10/19/2022 11:42:03 AM

Document Has Been Signed on 10/19/2022 11:42 AM - 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:WESTWOOD FAMILY HOMEFACILITY NUMBER:
306002874
ADMINISTRATOR:MANSUETO T. CONANAN, JR.FACILITY TYPE:
735
ADDRESS:910 N. WESTWOOD AVENUETELEPHONE:
(714) 973-0755
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY: 6CENSUS: 6DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jesus Koh, caregiver
Ella Alcantara, caregiver		TIME COMPLETED:
12:00 PM
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On 10/19/2022 , Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Jesus Koh, caregiver after explaining the purpose of the visit and being temperature checked.

LPA accompanied by caregiver toured the physical plant. There are currently six (6) clients in care, all of which are ambulatory. One client is currently hospitalized. At the time of the visit, two (2) clients are present while attending their day program online while three (3) other clients are attending their respective programs in person. The three (3) bedrooms include all necessary components. An ample supply of linen is observed. The shared bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. Staff present is adequately cleared and associated in Guardian. Administrator certificates are up to date. The fire extinguisher present is mounted and charged. The maintenance tag attached is current.

Sharp instruments are stored in a kitchen drawer secured by a key lock. The centrally stored medication are located in a locked file cabinet in the dining area. Cleaning supplies are locked under the sink and in the laundry area cabinet. LPA observed a sufficient supply of food and water present.

LPA and caregiver toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and a shaded area are present for the enjoyment of clients and visitors. The entry gate can easily be opened in an evacuation. There are no bodies of water on the premises

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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