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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 11/08/2021
Date Signed: 11/08/2021 03:24:37 PM

Document Has Been Signed on 11/08/2021 03:24 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:QUALITY CARE PLUSFACILITY NUMBER:
306003744
ADMINISTRATOR:MARJAN ARASTOOFACILITY TYPE:
735
ADDRESS:1652 W. BROADWAYTELEPHONE:
(714) 635-6561
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 80CENSUS: 74DATE:
11/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Marjan ArastooTIME COMPLETED:
03:37 PM
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Licensing Program Analysts (LPAs) Joseph Alejandre and Jerome Haley made an unannounced visit to conduct a health and safety inspection of the facility. LPAs were greeted and granted entry by Administrator Marjan Arastoo. LPAs and Administrator toured facility. LPAs observed all the lighting in the building hallways and med room were operational. LPAs observed the elevator is operational and its inspection certificate is not expired. LPAs did not observe the state license or the PUB 475 poster (see something, say something poster) mounted in the entry way or main hallway of the facility. LPAs inspected the kitchen and observed the facility has a 2 day perishable and 7 day non-perishable food supply on hand. LPAs observed the food supply contained fresh vegetables, fruits and fresh juice. LPAs observed the kitchen and restrooms on the first floor have hot water. LPAs observed the hallways and stairways were free of obstructions and hazards. LPAs observed the cleaning chemicals are kept locked in a closet and inaccessible to residents. LPAs observed residents watching TV in the main room by the entrance. LPAs toured the second floor of the facility. LPAs interviewed staff and residents. Administrator reported they are waiting for the ice machine ordered to arrive and have scheduled the repair person for the call signal system. LPAs toured the exterior of the facility. No obstacles or hazards observed. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2021
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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