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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003424
Report Date: 03/08/2022
Date Signed: 03/08/2022 03:41:43 PM


Document Has Been Signed on 03/08/2022 03:41 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:ROSE GARDEN BOARD AND CAREFACILITY NUMBER:
306003424
ADMINISTRATOR:ROSEMARIE ONGFACILITY TYPE:
740
ADDRESS:767 S. YORBA STREETTELEPHONE:
(714) 516-9410
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:6CENSUS: 2DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Pilardo Espinosa & Rosemarie OngTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Kathrina Chin made an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Rosemarie Ong and stated the purpose of this visit.

The facility is a single level structure and licensed for six non-ambulatory residents. There is one resident on hospice.

LPA Chin was granted entry after completing the COVID 19 screening procedure. For this visit, there is two resident in care and two staff members on the floor. LPA toured the interior and exterior portions of the facility. There were four private resident’s rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke detectors, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair; and provided with handrails and nonskid - floor mats. Hot water was measured at 105 degrees Fahrenheit. Facility met the minimum two day perishable and seven day non perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had outdoor furniture and covered patio. The grounds were free of tripping hazards. Side exit door was self-latching and self-closing. LPA Chin reviewed the COVID 19 mitigation plan of the facility.


For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Rosemarie Ong and copy of this report was left in the facility
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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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