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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 12/09/2021
Date Signed: 12/10/2021 08:59:23 AM

Document Has Been Signed on 12/10/2021 08:59 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
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: 73DATE:
12/09/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Marjan ArastooTIME COMPLETED:
05:30 PM
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Licensing Program Analysts (LPAs) Lydia Martinez, Albert Marin and Licensing Program Manager (LPM) Luz Adams made an unannounced visit to the facility to continue the Case Management that was started on 12/08/2021 by LPA Martinez. LPA's met with Licensee/Administrator (AD) Marjan Arastoo and stated the reason for the visit. Staff Abdul Arastoo arrived shortly after.

LPA's and LPM along with AD Marjan and Abdul conducted a tour of the facility’s physical plant, including the inside of the facility and no immediate health/safety hazards were observed. LPA's inspected random client rooms, bathrooms, kitchen and food service.



Facility's food supply was observed to be in quantity to meet the regulatory requirements during this inspection. Facility menu is posted and meal service for dinner was consistent with the posted menu. Meal consisted of protein, vegetables, carbohydrate and dessert. Fruit juice, tea and water were available for consumption. Hygiene supplies were observed centrally stored in the office. Common bathrooms were clean and observed to have toilet paper, paper towels and hand soap. Staffing was observed as follows: 1 Administrator, 2 Carestaff, 1 Server. Staff Abdul Arastoo is preparing facility meals while Cook returns on 12/14/2021.

Facility currently has 73 clients. AD was reminded that she can not admit new clients until the facility is fully staffed to which AD acknowledged. LPM discussed with AD Marjan and Abdul the staffing resource information. They were provided with list of Staffing Registry.

Microsoft Teams meeting was conducted with Regional Manager (RM) Marina Stanic during this visit. Licensee and AD were informed of 9 clients evaluated by Orange County Mental Health and determined needing higher level of care.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 PLUS
FACILITY NUMBER: 306003744
VISIT DATE: 12/09/2021
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The Licensee will issue 30 day eviction notice to clients C1 thru C9 (see LIC811) date 12/09/2021 and submit copy of said Notices to CCLD by close of business today. RM Stanic reiterated requirements needing to be met by due date of 12/15/2021 as discussed at NCC meeting. Licensee was encouraged to work closely and corroboratively with CCL staff.

Staff were observed to be wearing face mask. Hand sanitizer was observed at medication counter. Residents have been accommodated with Pfizer Booster shot.

Licensees were advised to continue to follow CDC Guidelines and COVID-19 Mitigation Plan.

Due to time constraints, POC visit will be conducted at a later date. LPA Martinez conducted an exit interview with AD Marjan, and copy of this report and list of Confidential Names (LIC811) will be emailed.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
LIC809 (FAS) - (06/04)
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