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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 02/03/2022
Date Signed: 02/03/2022 04:58:01 PM

Document Has Been Signed on 02/03/2022 04:58 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: 50DATE:
02/03/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marjan ArastooTIME COMPLETED:
05:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a health and safety check. LPA was greeted and granted entry by staff. LPA met with Administrator Marjan Arastoo and explained the reason for the visit. LPA and the Administrator toured the facility. LPA observed the facility has their State License posted. LPA observed the fireplace in the dining room has a metal screen. The dining room has 9 tables and numerous chairs and can accommodate all of the clients. The dining room is well lit and no obstacles or hazards were observed. The exit door leading outside from the dining room is operational. LPA and Administrator toured the kitchen. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. LPA observed a utility sink in the kitchen was leaking from the drain pipe. The kitchen was clean and the stove is operational. LPA observed a staff member preparing for the dinner service. LPA observed the fire extinguisher is fully charged. The exit door leading from the kitchen to the outside of the facility is operational. LPA observed the outside area from the kitchen exit door had old clothes, a clock and some boxes. LPA observed the door to the storage room in the kitchen, next to the ice machine, was missing a door knob. LPA observed there was no activity schedule posted, there was a current monthly menu posted next to the dining room entrance. Administrator reported there are daily activities but no calendar is available. LPA and the Administrator inspected one of the rooms on the first floor. LPA measured the hot water in room 110, it measured 107 degrees Fahrenheit. LPA measured the hot water in the shared restroom on the first floor it measured 112 degrees Fahrenheit. LPA and Administrator toured the second floor of the facility. LPA measured the hot water in second floor shared bathroom, it measured 110 degrees Fahrenheit. LPA observed all the light fixtures are working and all of the fire extinguishers are fully charged. LPA observed furniture and mattresses on the end of the hallway on the second floor. There were 2 mattresses and 2 night stands pushed up against the walls, access was still possible down the middle of the hall. LPA reviewed medication records of 5 clients, no discrepancies noted. LPA reviewed 5 client files. LPA observed that 4 out of 5 clients had a needs and service plan that was 2 years old. 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: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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 02/03/2022 04:58 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 02/03/2022 at 03:45 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: 02/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2022
Section Cited
CCR
85079(e)

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Activities. In facilities with a licensed capacity of 50 or more clients, a current, written program of activities shall be planned in advance and made available to all clients. This requirement is not being met as evidenced by, LPA observed there are no postings for any activities.
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Licensee states that an activity schedule/calendar will be made each month and it will be posted and available to clients. Proof to be submitted to LPA by POC due date.
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Administrator verified there is no printed activity schedule or calendar. This poses a potential health and safety risk to clients in care.
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Type B
02/11/2022
Section Cited
CCR80087(a)

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Buidlings and Grounds. The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not being met as evidenced by, LPA observed a leaking sink drain pipe in the kitchen.
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Licensee states the utility sink in the kitchen will be repaired so it does not leak. Licensee states the untility sink will be repaired by the POC due date. Licensee states a new door knob will be installed on the kitchen storage door by the POC due date.
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LPA also observed the door to the storage room in the kitchen, next to the ice machine, was missing a door knob. This poses a potential health and safety risk to clients and staff.
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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:Luz Adams
LICENSING EVALUATOR NAME:Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2022


LIC809 (FAS) - (06/04)
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