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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002983
Report Date: 07/19/2022
Date Signed: 07/19/2022 12:33:36 PM

Document Has Been Signed on 07/19/2022 12:33 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:GILBERT CARE HOMEFACILITY NUMBER:
306002983
ADMINISTRATOR:NOEL/ARLYN VILLEGASFACILITY TYPE:
735
ADDRESS:10412 GILBERT STREETTELEPHONE:
(714) 491-1230
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 5DATE:
07/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Noel Villegas, AdministratorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA arrived to facility there was no answer, LPA spoke to Administrator via telephone call and advised of visit. Caregivers arrived shortly after and LPA was greeted and granted entry into the facility. Noel Villegas, Administrator arrived and met with LPA.

LPA Martinez began the tour of the inside and outside of the facility accompanied by caregiver. There are five clients in care and there are no active covid-19 cases in the facility. LPA was informed that clients were out in the community in their day program. LPA observed a check in station in the main entry of the facility. Facility is taking temperatures daily and documenting the results. LPA observed required department postings, covid-19 precautionary postings in the facility as well has hand washing signs. Restroom observed to have a supply of soap and hand towels. Restroom appeared to be clean and sanitary. LPA inspected client’s bedrooms and they appeared to be clean and sanitary. All bedrooms were observed to have all required components. LPA observed the emergency disaster and evacuation plan. LPA observed the facility has a back-up emergency food and water supply. PPE supplies were observed in hallway storage as well as attached garage. LPA toured the outside of the facility and observed a seating area for client’s enjoyment.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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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