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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003566
Report Date: 03/24/2022
Date Signed: 03/24/2022 10:55:04 AM


Document Has Been Signed on 03/24/2022 10:55 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:FRANCEL GUEST HOME IIFACILITY NUMBER:
306003566
ADMINISTRATOR:FRANCISCO BALISIFACILITY TYPE:
740
ADDRESS:9441 HOUSTON AVENUETELEPHONE:
(714) 844-2527
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:14CENSUS: 12DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Francisco BalisiTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Christine Balisi's Administrator's Certificate expires 9/18/2023. Facility is a single story home with 8 bedrooms (1 bedroom is for staff), 4 bathrooms, living room, dining room and kitchen. In the backyard there is a storage shed which has 3 rooms and a storage room. The storage shed is for supplies and each room is kept locked. The storage room is kept locked and is for extra food. There are 5 refrigerators in the storage room each filled with different types of food. LPA and staff toured the facility. LPA observed all resident rooms had the required furnishings. LPA observed all resident rooms are shared rooms. LPA observed all bathrooms are operational and clean. Hot water measured 106.1 to 115.3 degrees Fahrenheit. LPA observed a 2 day perishable and 7 day non-perishable food supply in the kitchen. LPA observed the knives are kept locked in a kitchen drawer and the cleaning supplies are kept locked under the sink. The kitchen is clean and organized. LPA observed the fireplace in the living room has a piece of wood mounted to cover the opening. LPA and staff toured the backyard. There is a covered patio with a seating area for residents to sit outside. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA observed medication is kept locked in a medication cart, the cart is kept secured in the staff bedroom which is locked. Administrator Christine Balisi arrived at 10:10 am. LPA consulted with the Administrator about continued Covid-19 mitigation procedures and reporting requirements. Facility has a mitigation plan that is pending approval. No deficiencies observed during the visit. No deficiencies are being cited as a result of the visit.. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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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