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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003049
Report Date: 02/16/2023
Date Signed: 02/17/2023 08:34:07 AM

Document Has Been Signed on 02/17/2023 08:34 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CEDAR GUEST HOMEFACILITY NUMBER:
306003049
ADMINISTRATOR:LIGAYA GARCIANOFACILITY TYPE:
735
ADDRESS:8667 CEDAR DRIVETELEPHONE:
(714) 484-0227
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Yvellete TantiadoTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control. LPA Martinez met with Staff Angela Farro and reason for the visit was explained. Staff confirmed there are currently no cases or exposures of COVID-19 within the facility. Administrator Ligaya Garciano arrived shortly after but had to leave to take 2 clients to the dentist. Assistant Administrator Yvellete Tantiado arrived shortly after and reason for visit was explained.
LPA observed the required Department posting on COVID-19 precautions at entrance of facility. There is a sign-in procedure in place and hand sanitizer for use. Facility does temperature and symptom check visitors. LPA observed that staff were wearing face mask. The facility has an approved Mitigation Plan on file with CCLD. There were 6 Clients present during this visit; 2 left with Administrator to the Dentist during the visit. LPA conducted a tour of the facility and made observations pertaining to the facility's Infection Control measures. LPA toured all Client bedrooms, all rooms were within regulations. Clients appeared clean and happy. All restrooms observed contained hand washing soap, toilet paper and paper towels and had the proper hand washing signs posted. Facility has operating smoke and carbon monoxide detectors. Facility has Fire Extinguishers which were charged. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available. The facility monitors the clients regularly for any COVID-19 symptoms/change of condition and documents. Facility has required Emergency Disaster Plan posted, and a secured location for client's medication and files. Facility has 30 days supply of medications for the clients.
LPA consulted with Administrator and Assistant Administrator on PIN 23-03 dated 2/10/2023.

Based on observations made during today’s inspection, no deficiencies are being cited per Title 22, Division 6, of the California Code of Regulations. LPA reviewed this report with Administrator and a copy will be sent to email on file.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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