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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002986
Report Date: 07/23/2024
Date Signed: 07/23/2024 12:03:55 PM

Document Has Been Signed on 07/23/2024 12:03 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GILBERT CARE HOME-MARKEVFACILITY NUMBER:
306002986
ADMINISTRATOR/
DIRECTOR:
NOEL/ARLYN VILLEGASFACILITY TYPE:
735
ADDRESS:1430 S MARKEV STREETTELEPHONE:
(714) 995-1542
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 6DATE:
07/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:59 AM
MET WITH:Arnold Andal - AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:19 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by Administrator Arnold Andal.

The facility is a one-story home with six client bedrooms, three client bathrooms, one staff room, kitchen, dining room, living room, backyard, laundry room and detached 2-car garage. All client rooms had required elements, including bed, chair, closet space and ample lighting. Facility has extra linens and supplies for clients in the hallway closet. Restrooms are stocked with soap and paper towels. LPA measured water in client bathrooms to be between 105 and 120 degrees Fahrenheit. LPA noted Fire Extinguishers were last serviced on 07/10/2024 according to the service tag on them. LPA observed the smoke/carbon monoxide detectors to be operational. Facility keeps emergency water and emergency disaster supplies in the living room.



LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in cabinets. Knives are locked up separate from toxic chemicals. Medication for each resident is kept locked in a closet in the kitchen. The backyard has a shaded sitting/lounging area. Exit gate is unlocked. LPA observed exit gates to be unobstructed. LPA observed a sample menu and activity calendar in the facility. LPA reviewed three of the six client files and three staff files. LPA also reviewed medication for three out of six clients and the P&I for three out of six clients. LPA interviewed one client and one staff.

Based on today's inspection, no deficiencies are being issued. An exit interview was conducted 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: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
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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