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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 12/16/2021
Date Signed: 12/16/2021 04:36:50 PM

Document Has Been Signed on 12/16/2021 04:36 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: 73DATE:
12/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Marjan ArastooTIME COMPLETED:
04:55 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 Analysts (LPAs) Joseph Alejandre and Jerome Haley made an unannounced case management inspection to check on the Health and Safety of the clients and the plan of corrections for violations cited during previous visits. LPAs met with Administrator Marjan Arastoo and explained the reason for the visit. LPAs and Administrator toured the facility. Administrator provided LPAs with a receipt showing 10 new mattresses have been purchased and will be delivered on 12/17/21. LPAs observed that the bathroom sink in room 214 has been repaired and is no longer leaking. The blinds in room 223 have been replaced and are operational. The blinds in room 201a are in the processing of being replaced. LPAs observed in room 207 that the bathroom door was off the hinges and the door frame and door had chipped paint. Administrator reported that the resident of the room had damaged the door. LPAs observed in rooms 223 and room 204 that the window screens are torn and in disrepair. LPAs observed the window blinds in room 204 are broken and in disrepair. LPAs observed the screen for room 220 is missing. LPAs measured the hot water temperature in rooms, 220, 204, 213 and 101, temperature measured between 106.3 to 117.1 degrees Fahrenheit. LPAs inspected the kitchen. LPAs observed a 2 day perishable and 7 day non-perishable food supply on hand. LPAs observed the fireplace in the dining room is open and not screened. Administrator reported that the fireplace is never used. LPAs observed 8 total staff working at the facility including the Administrator. Administrator provided the LPAs with a staff roster (LIC 500) and a client roster. LPAs consulted with the Administrator concerning evictions and maintenance of the facility. Based on observations made during today's inspection , deficiency will be cited per Title 22 Division 6 of the California Code of Regulations. See LIC 809D. An exit interview was conducted with the Administrator and a copy of the report provided along with appeal rights.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2021
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 2
Document Has Been Signed on 12/16/2021 04:36 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 12/16/2021 at 04:04 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: 12/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2021
Section Cited
CCR
80088(b)

1
2
3
4
5
6
7
Furniture, Fixtures, Equipment, and Supplies. All window screens shall be in good repair and be free of insects, dirt and other debris. This requirement is not being met as evidenced by;
1
2
3
4
5
6
7
Licensee agrees to replace the damaged window screens in rooms 204, 223 and to put a new screen on the window for room 220 by POC due date 12/20/21.
8
9
10
11
12
13
14
LPAs observed that in rooms 204 and 223 the windows screens were torn and in disrepair and the screen for room 220 is missing. This poses a potential health and safety risk for clients in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Luz Adams
LICENSING EVALUATOR NAME:Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2021


LIC809 (FAS) - (06/04)
Page: 2 of 2