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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003734
Report Date: 03/28/2024
Date Signed: 03/28/2024 04:59:58 PM

Document Has Been Signed on 03/28/2024 04:59 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:JAIRE HOME IFACILITY NUMBER:
306003734
ADMINISTRATOR:LOUISE IGISAIARFACILITY TYPE:
735
ADDRESS:800 LA REINA STREET, N.TELEPHONE:
(714) 995-5575
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 6DATE:
03/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Louise Igisaiar- AdministratorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose to conduct the Required 1 Year Annual Inspection. LPA was greeted by Care Staff (CS) Mary Jane Amurao and was granted entry. Administrator Louise Igisaiar arrived on premise approximately 12:20pm, and LPA explained the purpose of the visit.

This is a single story, Level 4a facility comprised of six client bedrooms and one staff bedroom with three client bathrooms, living room, dining area, kitchen, attached laundry room and a two-car garage, two sheds, and a swimming pool. LPA toured inside the facility. LPA observed the client bedrooms had all the required elements with ample lighting. Showers, faucets, and toilets were clean and sanitary. The hot water temperature measured at 118.5, 118.5, and 105.2 degrees Fahrenheit in all three bathrooms. The hot water for one of the double sink did not reach the required temperature. There were sufficient and clean supply of linens. LPA observed ample two-day supply of perishables and seven-day supply of non-perishables. LPA observed emergency food, water, and supplies. The carbon monoxide and smoke detectors were tested and operational. The fire extinguisher was mounted, charged, and serviced on March 19, 2024. Medications, toxins, and sharps were locked and inaccessible to the clients. LPA toured the outside grounds. Both exit gates were self-closing and self-latching. The swimming pool was secured and gated above 5 feet and did not obstruct the view of the pool. There was sufficient shading and seating for the clients. The following items were posted and reviewed: Emergency Disaster Plan (LIC610D), food menu, activities, client's rights, and the Complaint Poster (PUB475). LPA reviewed six out of six client files/medications/P&I funds. Discrepancies were observed documenting the ledgers accurately. LPA also reviewed two out of the two staff files and interviewed three clients and two staff.

Administrator was advised on the following: to repair one of the double sink to ensure that the hot water is working and to accurately document the P&I ledgers.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: JAIRE HOME I
FACILITY NUMBER: 306003734
VISIT DATE: 03/28/2024
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Based on today's observations, no deficiency is being cited as per the Title 22 Division 6 Chapter 6 of the California Code of Regulations. Technical Advisories are being issued.

An exit interview was conducted with Administrator Louise Igisaiar, and a copy of this report including the LIC9099C, and the Technical Advisories were provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC809 (FAS) - (06/04)
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