306002984-3-18-2024-22-AS-JHAY-D3H2L9-20240318172911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002984
Report Date: 03/18/2024
Date Signed: 03/18/2024 05:29:15 PM

Document Has Been Signed on 03/18/2024 05:29 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 HOME-VICTORIA		FACILITY NUMBER:	306002984
ADMINISTRATOR:	NOEL/ARLYN VILLEGAS		FACILITY TYPE:	735
ADDRESS:	1935 W. VICTORIA AVENUE		TELEPHONE:	(714) 491-2171
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	6	CENSUS: 5	DATE:	03/18/2024
TYPE OF VISIT:	Case Management - Health Checks	UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Noel Villegas - Licensee/Administrator		TIME COMPLETED:	05:35 PM

NARRATIVE

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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced Case Management visit. LPA Haley was greeted and granted entry by staff and stated the purpose of the visit upon entry. Upon entering the facility, LPA Haley was led on a brief tour of the interior and exterior portions of the facility.

During the tour, LPA Haley observed an adequate food supply that meets regulation requirements. The hot water was measured at 108.2 degrees Fahrenheit in bathroom 1 (Women's) and 109.5 degrees Fahrenheit in bathroom 2 (Men's). Knives and sharp objects were locked in a drawer near the dishwasher, and medications were locked in a closet near the front door next to the clients bedroom.

A Health and Safety check was conducted on the 5 clients present during the visit. Three clients were observed in the dining room at the table room, and two other clients were in their room. One client was at work during the time of the visit. Client 1 (C1) was observed in the bed in the client bedroom near the front door.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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