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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003807
Report Date: 12/14/2022
Date Signed: 12/14/2022 11:44:49 AM


Document Has Been Signed on 12/14/2022 11:44 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:CHATEAU FRANCESCAFACILITY NUMBER:
306003807
ADMINISTRATOR:MARIZA OLIVAFACILITY TYPE:
740
ADDRESS:33821 VIA CASCADATELEPHONE:
(949) 234-0559
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:6CENSUS: 5DATE:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mariza OlivaTIME COMPLETED:
11:56 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Facility staff contacted the Administrator who stated she was on her way to the facility. Facility has 5 bedrooms, 1 is for caregivers, living room, dining room, kitchen, family room, 2 bathrooms and a 2 car garage. LPA observed the Ombudsman and See Something Say Something (PUB 475) poster posted in the living room adjacent to the entrance way. LPA observed the fireplace in the living room is screened. LPA inspected the kitchen and medications with staff present. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand. LPA observed the knives are kept locked in a kitchen cabinet. LPA observed the stove top lights unassisted. LPA observed the medication is kept locked in a kitchen cabinet. LPA observed there is a plastic basket for each resident that holds their medication. Administrator Mariza Olivia arrived at 10:00am. Mariza Olivia's Administrator's certificate expires on 5/4/2024. LPA observed 3 of the hallway ceiling light fixtures have no light bulbs. Administrator reported that the fixtures are operational they just don't have light bulbs. Staff located extra light bulbs and placed them in the empty fixtures. All fixtures have a light bulb and are operational. Smoke detectors/carbon monoxide detectors tested operational. Hot water measured 110.0 degrees Fahrenheit. LPA observed both bathrooms are clean and operational. LPA and Administrator toured the backyard. LPA observed a table and chairs with an umbrella for residents to sit outside., Both exit gates are operational. No bodies of water observed. No obstacles or hazards observed. LPA and Administrator toured the garage. The garage is kept locked and used for storage. LPA observed the facility has temperature/Covid-19 symptom logs for all residents. LPA observed that Resident 1 (R1) has a follow up doctor's appointment (See LIC 809 dated 9/23/22). Administrator reported this is a follow up appointment for an appointment last month. LPA consulted with Administrator concerning continued Covid-19 mitigation and reporting requirements. No deficiencies observed during this visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
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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