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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003080
Report Date: 04/03/2024
Date Signed: 04/03/2024 10:23:17 AM

Document Has Been Signed on 04/03/2024 10:23 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:RAINIER COURTFACILITY NUMBER:
306003080
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		EDNA ROJASFACILITY TYPE:
735
ADDRESS:1758 SOUTH RAINIER COURTTELEPHONE:
(714) 991-9711
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 6DATE:
04/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
08:24 AM
MET WITH:Facility Administrator - Edna RojasTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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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) Luis De Jesus. LPA met with facility administrator (AD) Edna Rojas. For this visit, there are a total of 6 clients in care. The PUB475 "See Something, Say Something" poster was observed to be in the hallway. LPA observed the Administrator's Certificate for Edna De Jesus, which expires on 6/29/24, and is posted at the entrance of the facility.

LPA De Perio toured the interior and exterior portions of the facility with S1. The facility is a single level structure and is licensed for 6 clients.

LPA observed that there are a total of 5 bedrooms, of which 1 is for staff and 2 private client rooms, and 2 shared client rooms. 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. LPA observed that there are two bathrooms in the facility. The restrooms were observed to be in good repair, toilets were operational. Water temperature in restrooms were measured at 110.7 degrees Fahrenheit.

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, mounted and located in the kitchen. LPA De Perio observed the emergency disaster and evacuation plan, which is posted in the kitchen. Facility had back-up emergency food and water supply, located in the kitchen and in the garage. LPA De Perio observed that First Aid Kit had all the required components. Medications and toxins were locked in a cabinet and is made inaccessible to clients.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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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: RAINIER COURT
FACILITY NUMBER: 306003080
VISIT DATE: 04/03/2024
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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. No bodies of water were observed.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

LPA De Perio conducted an exit interview with S1.

A copy of this report was provided and explained.

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

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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