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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003412
Report Date: 01/16/2025
Date Signed: 01/16/2025 10:35:33 AM

Document Has Been Signed on 01/16/2025 10:35 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:CENTER CARE HOMEFACILITY NUMBER:
306003412
ADMINISTRATOR/
DIRECTOR:
GILBERT SINGHFACILITY TYPE:
735
ADDRESS:17135 SANTA CATHERINE STREETTELEPHONE:
(714) 588-4141
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 6CENSUS: 4DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:55 AM
MET WITH:Gilbert SinghTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analysts (LPA) Samer Haddadin conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was greeted and granted entry into the facility by Administrator (AD) Gilbert Singh and discussed the purpose of the inspection.

LPA reviewed Two clients’ files and two staff files. Client files and staff files contained all required documentation. Administrator certificate expires on March 25th, 2025.

LPA along with AD toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. This is a two-story house with four client bedrooms, two staff bedrooms and three total bathrooms. At the time of the visit, one client was observed at the facility and three were in day program.The facility has a kitchen, dining room, and living room with an attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms; all were tested and operational. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each client comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew.

Water temperature measured in first restroom at 105.6 and 106.8 F degrees in the second restroom. Bath towels, and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards and doorways were free of obstructions.

First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected and appliances were operational. LPA observed the facility had a two-day supply of perishables and a seven-day supply of non-perishable food was available as required by regulations. LPA observed sharps and knives locked in a kitchen cabinet. LPA also observed toxin substances secured and locked and were inaccessible to clients in a storage closet in the garage.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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: CENTER CARE HOME
FACILITY NUMBER: 306003412
VISIT DATE: 01/16/2025
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Fire extinguisher was fully charged with last inspected on June 14th,2024. The facility’s last fire drill was conducted on January 14th,2025 and AD conducts drills quarterly. LPA toured the backyard and observed there is a shaded seating area and space for activities.

Based on today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to AD.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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