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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003734
Report Date: 03/05/2025
Date Signed: 03/05/2025 01:12:13 PM

Document Has Been Signed on 03/05/2025 01:12 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/
DIRECTOR:		LOUISE IGISAIARFACILITY TYPE:
735
ADDRESS:800 LA REINA STREET, N.TELEPHONE:
(714) 995-5575
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 6DATE:
03/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:06 PM
MET WITH:Ariel ResurreccionTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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LPA Samer Haddadin made an un announced visit to conduct an Annual at this facility.
LPAs were greeted and granted entry by staff Ariel Resurreccionand explained the purpose of the inspection.

During the inspection LPA and Staff conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:


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.
LPA observed clients resting and watching television in the living room. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 116.6-118.6 F degrees.
During record review, LPA observed PNI to be in order and accounted for.
LPA observed the facility to have a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. However, the facility did have enough emergency food water on hand located in the garage..
Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated January 31, 2025.
The swimming pool was secured and gated above 5 feet and did not obstruct the view of the pool.
Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients. Medication cabinet was observed to be locked.

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 provided to AD at end of inspection.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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