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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 12/27/2021
Date Signed: 12/27/2021 12:33:21 PM

Document Has Been Signed on 12/27/2021 12:33 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:
12/27/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marjan and Abdol ArastooTIME COMPLETED:
12:47 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Kimberly Lyman and Jerome Haley are conducting this case management visit for the purpose of a health and safety check. LPAs arrived at the facility and were greeted and granted entry by Administrator Marjan Arastoo. LPAs explained the nature of the visit to Administrator.

Upon entry, LPA observed clients in care throughout the facility in the exterior and interior of the physical plant. LPAs observed 7 staff including both Administrator and Assistant Administrator. LPAs accompanied by Marjan Arastoo, Administrator, toured the physical plant of the facility. LPAs toured the kitchen; it was observed that kitchen has a 2 day supply of perishables and a 7 day non-perishable food available. LPAs observed the kitchen work areas were clean and dishes were being washed, staff was prepping food for lunch. LPAs observed clients eating hamburgers and potato salad for lunch accompanied by iced tea or juice. During the tour, LPA observed staff in medication room, kitchen, caregivers on the floor and housekeeping in the facility. LPAs observed all fire extinguishers are fully charged. LPA observed hallways and walkways were free of obstruction. Facility does not have a dedicated emergency water supply in the facility. LPAs observed ample back up linens, cleaning supplies, and PPE supply. LPAs observed new mattresses for replacement as well as new dresser drawers to be assembled for clients. LPAs observed the fireplace is not screened and facility was given an advisory note on 12/16/2021 to address the fireplace. Facility does not have a covid check in station at entrance of facility. Administrator states in process of hiring a security guard. LPAs spoke with five of the nine clients who had been served with eviction notices. All five verbalized non-compliance with the notice. Administrator provided LPA with a copy of the updated LIC 500.

Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with Administrator
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2021
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 12/27/2021 12:33 PM - It Cannot Be Edited


Created By: Kimberly Lyman On 12/27/2021 at 11:59 AM
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: 12/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2022
Section Cited
CCR
80088(c)(1)

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Fireplaces and open-faced heaters shall be made inaccessible to clients to ensure protection of the clients' safety.
The use of a fireplace screen or similar barrier will meet this requirement. This requirement is not being met as evidenced by:
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Licensee to obtain a screen for the fireplace and forward proof to LPA by POC due date.
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Based on observation, Licensee failed to ensure fireplace is screened and inaccessible to clients in care. Facility was given an advisory note on 12/16/2021 to address the issue. This poses a potential 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:Alisa Ortiz
LICENSING EVALUATOR NAME:Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:
DATE: 12/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/27/2021


LIC809 (FAS) - (06/04)
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