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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002985
Report Date: 09/09/2024
Date Signed: 09/09/2024 11:58:44 AM

Document Has Been Signed on 09/09/2024 11:58 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
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GILBERT CARE HOME-HIAWATHAFACILITY NUMBER:
306002985
ADMINISTRATOR/
DIRECTOR:		NOEL/ARLYN VILLEGASFACILITY TYPE:
735
ADDRESS:2151 W. HIAWATHA AVENUETELEPHONE:
(714) 357-5617
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 4DATE:
09/09/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:01 AM
MET WITH:Noel Villegas - AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 9/9/2024, LPA Dwayne Mason Jr. arrived at the facility to conduct a Health and Safety check. LPA was greeted and granted entry by Caregiver Paul Michael Esteban. LPA spoke to administrator Noel Villegas via phone call and explained the reason for the visit. AD arrived approximately one hour following LPA's arrival.

LPA observed three clients lounging in living room. One client was already gone to day program upon LPA's arrival. LPA observed one client get picked up for day program during the inspection. Another client who is usually at day program was present at the facility due to having a doctor's appointment. LPA observed facility has running water, working electricity, working air conditioning/fans and working plumbing. LPA observed emergency exit to be unobstructed. LPA observed enough food in refrigerators and pantries. LPA observed additional groceries delivered to the facility during inspection. LPA observed sharps and medication to be locked up and the fire extinguisher to be fully charged.

Based on today's visit, no deficiencies are being issued. LPA reviewed this report with facility representation and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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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