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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002986
Report Date: 10/26/2023
Date Signed: 10/26/2023 10:54:10 AM


Document Has Been Signed on 10/26/2023 10:54 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-MARKEVFACILITY NUMBER:
306002986
ADMINISTRATOR:NOEL/ARLYN VILLEGASFACILITY TYPE:
735
ADDRESS:1430 S MARKEV STREETTELEPHONE:
(714) 995-1542
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 6DATE:
10/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Arnold Andal and Noel Villegas - AdministratorsTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into facility by DSP Wilfredo Mendoza. Administrators Arnold Andal and Noel Villegas joined the inspection between 10:00am and 10:15am.

The facility is a one-story home with six client bedrooms, three bathrooms, one staff bedroom, kitchen, dining room, living room, family room, backyard and detached garage. Resident activities include but are not limited to, puzzles, crosswords, positive thinking activities, watching concerts, going to movie theaters and more. One resident is passionate about making origami. Their origami can be seen as decoration throughout the facility. The facility has also won an award for being the most artistic. Facility appears clean and sanitary. All residents rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured at 112.6 degrees Fahrenheit in the bathroom nearest to the front door, 110.6 degrees Fahrenheit in the bathroom in the front hallway and 105.2 degrees Fahrenheit in the bathroom in the back hallway. LPA observed facility has emergency food and water supply. Medication for each resident is kept in a locked cabinet in the kitchen. LPA reviewed medication and MAR for three clients. Medication appears to be administered appropriately. LPA reviewed P&I. P&I funds were observed to be accurate and accessible to clients. The backyard has shaded seating areas. LPA observed an unused chair and electric wheelchair in the backyard. Facility has a plan to remove these items from the back yard. Exit gates are unlocked. Exit ramp was observed to be free of debris and obstruction. LPA reviewed three of the six residents files, each contained required documentation. LPA interviewed three residents.

No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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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