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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 03/10/2023
Date Signed: 03/10/2023 10:44:16 AM

Document Has Been Signed on 03/10/2023 10:44 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 & INLAND A/SC, 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: 63DATE:
03/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Marjan Arastoo, AdministratorTIME COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility for the purpose of a case management visit to review a recent client death reported. LPA was greeted and granted entry into the facility by staff. LPA met with Marjan Arastoo, Administrator and explained the nature of the visit.

During today’s visit LPA interviewed staff, toured the physical plant of the facility, reviewed client file, and obtained copies of pertinent documents. Client (C1) was last seen by staff the night of 02/26/23 at 11:30pm alert and laughing in bedroom. Administrator on 02/27/23 at 9:00am was talking a head count on clients and observed C1 was not at the facility. Administrator indicated for staff to call Anaheim Police Department and file a missing report. Anaheim police and Administrator followed up on the status of C1. On 3/8/23 Administrator heard from clients at facility that it was possible C1 had passed away. Administrator made a call to Anaheim Police Department to follow up and was instructed to call coroner’s office due to Police Department not having any new updates. Upon call to coroner’s office it was verified that C1 had passed away at the hospital on 2/27/23. Administrator called LPA DePerio to informed her of the update. Facility has not received a copy of OC Sheriff Corner’s office report.

An exit interview was conducted with administrator and a copy of this LIC809 report was provided and left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2023
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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