<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003735
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:34:37 AM

Document Has Been Signed on 03/12/2025 11:34 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:JAIRE HOME IIFACILITY NUMBER:
306003735
ADMINISTRATOR/
DIRECTOR:
ANA BIEN DEVERAFACILITY TYPE:
735
ADDRESS:1242 ALAMO STREETTELEPHONE:
(714) 635-3788
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 5DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:13 AM
MET WITH:Louise IgisaiarTIME VISIT/
INSPECTION COMPLETED:
12:45 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
Licensing Program Analysts (LPA) Samer Haddadin conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was greeted and granted entry into the facility by Administrator (AD) Louise Igisaiar and discussed the purpose of the visit.This is a single story, Level 4a facility comprised of six client bedrooms with two client bathrooms, living/dining area, kitchen, laundry room and a two-car garage, and one shed in the backyard The facility has a kitchen, dining room, and living room. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms; all were tested and operational. Client bedrooms had the required furniture: bed linens and closet/drawer and space to accommodate each client comfortably. Client bathrooms were checked. Toilets and water faucets worked properly: grab bars were secure, and shower was free of mold/mildew.Water temperature measured in first restroom at 111 Degree Fahrenheit and 109.8 Degree Fahrenheit in the second restroom. Bath towels, and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards and doorways were free of obstructions.First aid kit had all the required elements including bandages, tweezers, thermometer, scissors and a manual. Kitchen was inspected and all appliances were operational. LPA observed the facility had a two-day supply of perishables and a seven-day supply of non-perishable food was available as required by regulations. LPA observed sharps and knives locked in a kitchen cabinet. LPA also observed toxin substances secured and locked and were inaccessible to clients in a storage closet in the garage.LPA reviewed Two clients’ files and two staff files. Client files and staff files contained all required documentation. Administrator certificate expires on December 5th, 2025.

Fire extinguisher was fully charged with last inspected on January 23rd ,2025. The facility’s last fire drill was conducted on March 1st ,2025. LPA toured the backyard and observed there is a shaded seating area and space for activities.

Based on today’s visit, 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 provided to AD.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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 1