306003049-4-15-2024-22-AS-JHAY-D4CQSJ-20240415122537

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306003049
Report Date: 04/15/2024
Date Signed: 04/15/2024 12:26:43 PM

Document Has Been Signed on 04/15/2024 12:26 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	CEDAR GUEST HOME		FACILITY NUMBER:	306003049
ADMINISTRATOR/ DIRECTOR:	LIGAYA GARCIANO		FACILITY TYPE:	735
ADDRESS:	8667 CEDAR DRIVE		TELEPHONE:	(714) 484-0227
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY: 6		CENSUS: 1	DATE:	04/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:50 AM
MET WITH:	Ligaya Garciano - Licensee/Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:35 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analysts (LPA) Jerome Haley made an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Staff contacted Licensee/Administrator (AD) Ligaya Garciano who arrived a short time later and was present for the remainder of the of the visit.

During the inspection all client bedrooms and bathrooms were observed. All client bedrooms had the necessary elements and were in compliance with regulation guidelines.

Client bathrooms were clean and organized. Hot water temperatures were measured at 114 degrees Fahrenheit in both client bathrooms. No hazardous items were observed in the client bathrooms, and all grab bars were tightly secured to the wall.

In the kitchen, hazardous cleaning materials are kept locked under the sink. A perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the cabinets. Knives and sharp objects are locked in a cabinet right outside the kitchen area. Client medications are locked in a cabinet in the kitchen and two first aid kits are locked in the medication cabinet. All four burners on the stover were operational. There’s a fully charged fire extinguisher in the kitchen sitting behind the table.

There’s a small laundry room in the living room with a washer and dryer. Above the dryer there is a locked cabinet with soaps and additional hazardous cleaning items.

The garage was organized and walkways were free of obstruction. There was an extra refrigerator with an additional food supply. Additional items no longer being used that will be disposed of were observed. Each client had a box of old clothing they no longer wear and will be disposed of, and there were boxes of adult diapers on the shelves in the garage.

Continued on LIC809C

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 HOME	FACILITY NUMBER: 306003049
	VISIT DATE: 04/15/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

An emergency supply of water, latex gloves, surgical mask, N95 mask, and hand sanitizer and other COVID supplies items was observed in a locked cabinet right outside the kitchen.

The backyard was clean, organized, and walkways were free of obstruction. A shaded patio area with a table and chairs was observed.

Smoke detectors, and the carbon monoxide detector tested operational.

An emergency evacuation drill was conducted April 1, 2024 and are conducted monthly.

No deficiencies are being cited as a result of today’s visit.

An exit interview conducted, and a copy of this report was provided to Licensee/Administrator Ligaya Garciano.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2