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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003706
Report Date: 07/26/2024
Date Signed: 07/26/2024 10:21:06 AM


Document Has Been Signed on 07/26/2024 10:21 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:GLENWOOD CAREFACILITY NUMBER:
306003706
ADMINISTRATOR:DORA VILLAGRANFACILITY TYPE:
740
ADDRESS:2001 EAST GLENWOODTELEPHONE:
(714) 626-0796
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:6CENSUS: 4DATE:
07/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator, Dora VillagranTIME COMPLETED:
10:25 AM
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On 7/26/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Licensee Edvin Villagran and Administrator, Dora Villagran. The facility has a fire clearance for six (6) non-ambulatory elderly residents and an approved hospice waiver for six (6), and LPA was informed there are currently three (3) residents receiving hospice services at the facility.

LPA toured the facility with Administrator Villagran and observed the facility is made up of a one-story home with three (3) resident bedrooms, two (2) bathrooms, a staff room, kitchen, dining room, living room, and attached garage. During the tour, Administrator Villagran tested one (1) of the smoke alarm/carbon monoxide detectors and LPA observed it to be operational. LPA also observed three (3) charged fire extinguishers mounted throughout the facility, serviced on 5/8/2024. Indoor and outdoor passageways were free of obstruction. The facility has outdoor shaded seating for the residents in care. There were no bodies of water observed on the premises. A concrete wall secured the backyard. Medications are stored in a hallway cabinet that is secured with a master lock. Resident bedrooms had the required furniture and lighting. Resident bathrooms had grab bars and non-skid mats in the shower. LPA toured the kitchen and observed food was stored in a safe and healthful manner. The facility had more than a 2-day supply of perishable foods and 7-day supply of non-perishable food items. The facility also has additional clean linens, towels, and washcloths stored in different hallway cabinets. Additional food and incontinent supplies are stored in the garage. The living room fireplace has an appropriate screen to make it inaccessible for the residents in care. LPA reviewed random staff and resident files. Resident files reviewed had all Departmental required records. Staff present had a criminal record clearance and a valid first aid/CPR certification.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted where this report was reviewed and provided to Licensee Villagran.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: 951-248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024
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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