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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002921
Report Date: 02/14/2025
Date Signed: 02/14/2025 04:37:37 PM

Document Has Been Signed on 02/14/2025 04:37 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:SAINT NINO MANORFACILITY NUMBER:
306002921
ADMINISTRATOR/
DIRECTOR:		DIVINE A. OLEGARIOFACILITY TYPE:
735
ADDRESS:4110 W. ASH AVENUETELEPHONE:
(714) 879-2269
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 6CENSUS: 4DATE:
02/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Licensee Rolando OlegarioTIME VISIT/
INSPECTION COMPLETED:
04:52 PM
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Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by Licensee Rolando Olegario after explaining the purpose for the visit. LPA observed that Administrator (AD) Divine Olegario has a valid Administrator certificate which expires on May 2, 2026.

The facility is an Adult Residential Facility (ARF) licensed for six ambulatory clients. The facility is a single story home with four client bedrooms, two of which are shared, one shared client bathroom, one staff room, a living room, a dining room, a kitchen, a staff office, and an attached two car garage. LPA, accompanied by the Licensee conducted a tour of the interior portion of the facility. On today's visit, LPA observed four clients in care and one staff present. LPA observed clients returning from their Day Program and relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all four client bedrooms and they were observed to be free of any hazards. LPA observed the client bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA tested the smoke detector in each client bedroom and they were observed to be operational. LPA observed client beds had clean linens and blankets. LPA observed additional linens are stored in a closet in the client hallway. LPA inspected the shared client bathroom. The client bathroom was clean. The client bathroom was equipped with grab bars and nonskid floors. Faucet and toilet was operational. Hot water temperature measured 110.4 degrees Fahrenheit. LPA observed that the staff room is kept locked and inaccessible to clients in care.

LPA observed that the facility has a two day perishable and a seven day non-perishable food supply on hand in the kitchen. LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed knives and sharps to be stored in a locked closet by the kitchen.
CONTINUED ON 809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: SAINT NINO MANOR
FACILITY NUMBER: 306002921
VISIT DATE: 02/14/2025
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LPA observed the facility has a three day emergency food and water supply stored in the closet by the kitchen. A fire extinguisher is located in the kitchen and it was observed to be charged and serviced as of February 5, 2025. LPA tested the carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 6, 2025. The centrally stored medication is kept in a locked closet by the kitchen. LPA observed a First Aid Kit to be stored in the locked closet and it was observed to have all the required components. LPA observed a fireplace in the living room and it was observed to be adequately fenced and not in operation at time of visit. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to clients in care. LPA observed the garage to be used for storage and laundry.

LPA, accompanied by the Licensee conducted a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for client use. The perimeter gates on the west side and east side of the facility are self-latching and can be open in an evacuation. There is a pool located in the backyard which is adequately fenced and kept locked for client safety.

LPA reviewed all four client files. All the required documentation were present and current in the client files reviewed. LPA reviewed all four clients' medication and medication record. LPA reviewed all four clients' Personal and Incidental expense monies (P&I) records. LPA reviewed three staff files. All staff are background cleared and associated to the facility.

Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Licensee Rolando Olegario and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
LIC809 (FAS) - (06/04)
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