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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 01/03/2022
Date Signed: 01/03/2022 05:29:32 PM

Document Has Been Signed on 01/03/2022 05:29 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: 7DATE:
01/03/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Administrator Marjan ArastooTIME COMPLETED:
05:45 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 Analyst (LPA) Albert Marin made an unannounced visit to conduct a case management and health and safety check in this facility. LPA spoke to Administrator (AD) Marjan Arastoo and stated the purpose of this visit.

LPA Marin conducted a tour in the interior and exterior portions of the facility. LPA observed clients in the common areas and dining hall; and 3 staff members (care staff. care staff/kitchen, and administrator) on the floor. LPA checked random client's rooms. LPA toured the kitchen and observed the dinner service. Meal served was consistent with the posted menu.

LPA Marin reviewed the Coronavirus 2019 (COVID 19) mitigation plan of the facility. LPA observed log of temperature checks for staff and clients in care. AD M. Arastoo stated that about 98% of clients had received booster dose last December 2021. Staff were observed to be wearing masks while at work.

LPA also discussed best practices in documenting clients going out and coming back of the facility. AD will hold a meeting with clients to reinforce house rules; and to will also do staff training on endorsements.

AD Arastoo provided LPA with latest copy of personnel summary report.

For this visit, LPA Marin did not observed immediate threat on the health and safety of clients in care. No citation was issued at this time.

LPA Marin conducted an exit interview with AD Arastoo. Copy of this report was left in the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2022
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