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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002991
Report Date: 02/19/2025
Date Signed: 02/19/2025 11:19:46 AM

Document Has Been Signed on 02/19/2025 11:19 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VENTANA ARF-NOLANFACILITY NUMBER:
306002991
ADMINISTRATOR/
DIRECTOR:		HECTOR OBAR & E. OLIVARESFACILITY TYPE:
735
ADDRESS:22812 NOLAN STREETTELEPHONE:
(949) 458-7735
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 4CENSUS: 3DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:47 AM
MET WITH:Caregiver Julita RicafortTIME VISIT/
INSPECTION COMPLETED:
11:34 AM
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Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator Hector Obar was notified via telephone but could not arrive to assist with the inspection. LPA observed Hector Obar's Administrator certificate expired on May 14, 2024. However, LPA verified and confirmed that Hector Obar submitted an Administrator renewal application to the Administrator Certification Bureau (ACB) on April 19, 2024.

The facility is an Adult Residential Facility (ARF) licensed for four ambulatory clients, of which one may be non-ambulatory. The facility is a single story home with three private client bedrooms, two staff rooms, two shared client bathrooms, a living room, a dining room, a kitchen, a family room, a laundry room, and an attached two car garage. LPA accompanied by a care giving staff conducted a tour of the interior portion of the facility. On today's visit, LPA observed three clients in care and four care giving staff present. LPA observed client relaxing in their respective bedrooms. LPA inspected all three private client bedrooms, and they were observed to be free of any hazards. LPA observed client bedrooms have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. Client beds have clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the two shared client bathrooms. Bathrooms were clean. Faucets and toilets were operational. Hot water temperature measured between 119.5 and 119.8 degrees Fahrenheit. LPA observed that the two staff rooms are kept locked and inaccessible to clients in care.

LPA observed that the facility has a two day perishable and a seven day nonperishable food supply on hand in the kitchen. LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink.
CONTINUED ON 809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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: 02/19/2025
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A fire extinguisher is located in a hallway closet and it was observed to be charged and serviced as of June 18, 2024. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 22, 2025. The centrally stored medication is kept in a locked storage cabinet by the family room. LPA observed a First Aid Kit to be stored in the locked storage cabinet and it was observed to have all the required components. LPA observed a fireplace in the living room and it was observed to be adequately fenced and not in operation at time of visit. LPA observed the door leading to the laundry room is kept locked and inaccessible to clients in care. LPA observed chemicals and toxins to be stored in the laundry room. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to clients in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the two car garage.

LPA, accompanied by a care giving staff conducted a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for client use. The perimeter gates on the west side and east side of the facility are self-latching and can be open in an evacuation. There are no bodies of water on the premises.

LPA reviewed all three client files. All the required documentation were present and current in the client files reviewed. LPA reviewed all three clients' medication and medication record. LPA reviewed all three clients' Personal and Incidental expense monies (P&I) records. LPA reviewed five staff files. All staff are background cleared and associated to the facility.

Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. LPA spoke with Administrator Hector Obar regarding the outstanding annual fees for the facility. Administrator Hector Obar also advised LPA via telephone that caregiver Julita Ricafort was authorized to sign the report. An exit interview was conducted with caregiver Julita Ricafort and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
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