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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 11/09/2021
Date Signed: 11/10/2021 02:50:33 PM

Document Has Been Signed on 11/10/2021 02:50 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: 76DATE:
11/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Marjan ArastooTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced Case Management visit to check on the Health and Safety and Welfare of the clients in care. LPA was greeted and granted entry by Administrator (AD) Marjan Arastoo and reason for visit was discussed.

LPA and AD Marjan toured the facility. AD Marjan stated she has a prospective employee pending. AD stated she is only Caregiver/MedTech. LPA observed 2 Housekeepers. LPA inspected the kitchen and observed Assistant Administrator Abdol Arastoo serving lunch which consisted of vegetable soup, mixed salad with croutons and cottage cheese, half an apple and tea. LPA observed the facility has a 2 day supply of perishable and 7 day of non-perishable food on hand. LPA observed the food supply contained fresh vegetables, fruits and fresh juice. LPA observed toilet paper, paper towels and hand soap in all 3 common bathrooms, observed the hallways and stairways were free of obstructions and hazards, observed the cleaning chemicals are kept locked in a closet and inaccessible to clients. LPA observed clients smoking outside and others watching TV in the main room by the entrance. LPA toured the second floor and inspected several random rooms of the facility, interviewed random clients who stated lunch was delicious. LPA observed client in shared rooms 202A and client in shared room 211 smoking in their room. AD Marjan stated new ice machine was ordered back in July 2021 and have been told it's on back order and they have a repair man coming out this week to take a look at the call signal system. LPA noted dining room table cloths have been replaced with new ones.

Based on the observation made during today’s inspection, deficiency will be cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted with AD Marjan, a copy of report and Appeal Rights will be emailed.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2021
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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Document Has Been Signed on 11/10/2021 02:50 PM - It Cannot Be Edited


Created By: Lydia Martinez On 11/09/2021 at 01:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: QUALITY CARE PLUS
FACILITY NUMBER: 306003744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/12/2021
Section Cited
CCR
80087(a)

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Buildings and Grounds (a) The facility shall be kept clean, safe, sanitary… at all times. This requirement was not met as evidenced by:
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AD agrees to hand out notices to all Clients that refers to following facility house rules regarding smoking inside the rooms or inside building and consequences of breaking the house rules. Will be completed by 11/10/2021. Proof to be submitted to LPM by close of busines day of 11/10/2021.
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LPA and AD Marjan observed during inspection Client in shared rooms 202A and 211 were smoking in their room which poses a an immediate health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Marina Stanic
LICENSING EVALUATOR NAME:Lydia Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2021


LIC809 (FAS) - (06/04)
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