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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002991
Report Date: 03/22/2024
Date Signed: 03/22/2024 06:25:47 PM

Document Has Been Signed on 03/22/2024 06:25 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VENTANA ARF-NOLANFACILITY NUMBER:
306002991
ADMINISTRATOR:HECTOR OBAR & E. OLIVARESFACILITY TYPE:
735
ADDRESS:22812 NOLAN STREETTELEPHONE:
(949) 458-7735
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 4CENSUS: 3DATE:
03/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
05:29 PM
MET WITH:Staff on Duty - Reynaldo RicafortTIME COMPLETED:
06:35 PM
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty (S1) Reynaldo Ricafort. LPA observed the Administrator's Certificate for Hector Obar, which expires on 5/14/24. LPA observed the PUB475 "See Something Say Something" poster posted in the hallway.

LPA De Perio toured the interior and exterior portions of the facility with S1 Ricafort. The facility is a single level structure and is licensed for 4 clients, ages 18-59, of which 1 may be non-ambulatory. Currently, there are a total of 3 clients in care. There are a total of 4 bedrooms. All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards.

Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. The restrooms were observed to be in good repair, toilets were operational. Water temperature in restrooms were measured at 112.1 degrees Fahrenheit and hand washing signs were also posted in each restroom.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to clients in care. Fire extinguisher was charged, and located in the hallway. LPA De Perio observed the emergency disaster and evacuation plan, which is posted by the kitchen. Facility had back-up emergency food and water supply, located in the kitchen. Toxins were also observed to be locked and inaccessible to residents.



For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which was self-closing and self-latching.
LPA De Perio observed that First Aid Kit had all the required components.
No bodies of water were observed.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: VENTANA ARF-NOLAN
FACILITY NUMBER: 306002991
VISIT DATE: 03/22/2024
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For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

No citations were issued.

LPA De Perio conducted an exit interview with S1 Ricafort.

A copy of this report, was provided and explained.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
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