306003529-2-10-2025-22-AS-KSGH-D9AVX4-20240920164854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306003529
Report Date: 09/20/2024
Date Signed: 02/10/2025 09:14:45 PM

Document Has Been Signed on 02/10/2025 09:14 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	GUARDIAN ANGELS HOMES I		FACILITY NUMBER:	306003529
ADMINISTRATOR/ DIRECTOR:	SONIA GARCIA		FACILITY TYPE:	740
ADDRESS:	18021 E. SANTA CLARA AVENUE		TELEPHONE:	(714) 269-7307
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	09/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:15 PM
MET WITH:	Kelly Francia, Administrator Jonathan Harlan, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:00 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	On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the reason of the visit. Administrators Kelly Francia and Jonathan Harlan arrived later to assist with the visit. During the inspection, LPA and staff conducted a tour of the physical plant and observed the following: The facility is a one-story home with six private bedrooms in addition to one staff room. There are five bathrooms throughout the facility. All bathrooms are observed to be equipped with grab bars and slip mats. All resident bedrooms have the required furnishings. LPA observed all beds have linen and blankets. One bed is observed to be equipped with full bed rails and another one with half rails. Physician order and hospice plan of care reviewed as well as physician order for the half rails. There are currently five residents admitted to the facility, one of which is receiving hospice care. Bathrooms faucets and toilets are operational. Water temperature was measured to be approximately 116F and 118F. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Drills are conducted quarterly, and are documented and reviewed. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable. Smoke and carbon monoxide detectors tested operational. Fire extinguisher present is fully charged and has been maintained in 2024. There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on both sides of the property. The routes of egress are free of obstructions. There are no bodies of water on the premises. CONTINUED ON FORM LIC809-C

Sheila Santos	TELEPHONE: (714) 334-2062
Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

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: GUARDIAN ANGELS HOMES I	FACILITY NUMBER: 306003529
	VISIT DATE: 09/20/2024

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CONTINUED FROM FORM LIC809
Medication, cleaning products and sharp items are confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and reviewed to be accurate and up to date with the resident's prescription orders.

LPA reviewed five resident files and three staff files. Three staff and three resident interviews conducted. Resident records include all necessary components. All staff members are confirmed to be cleared and associated with this particular licensed location. Training records, health screenings and CPR training are on file and up to date.

Based on the observations made during today’s inspection, 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 left at the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

LIC809 (FAS) - (06/04)

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