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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003810
Report Date: 12/01/2021
Date Signed: 12/01/2021 10:30:48 AM

Document Has Been Signed on 12/01/2021 10:30 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:STARLIGHT GUEST HOMEFACILITY NUMBER:
306003810
ADMINISTRATOR:CAROL ODULIOFACILITY TYPE:
735
ADDRESS:11232 LOARA STREETTELEPHONE:
(714) 537-8045
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 6CENSUS: 6DATE:
12/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Muriel Lapined, CaregiverTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by caregiver. LPA explained the nature of the visit.

LPA Martinez began the tour of the inside and outside of the facility. There are six clients in care and there are no active covid-19 cases in the facility. LPA observed two clients in living room watching TV and remainder of clients were out in the community at the day program. Clients appeared to be clean and well taken care of. LPA observed required department postings, covid-19 precautionary postings in the facility as well as hand washing signs throughout the facility. All restrooms observed to have ample supply of soap/sanitizer and appeared to be clean. LPA inspected client’s bedrooms and they appeared to be clean and sanitary. All bedrooms were observed to have all required components. Clients bedrooms are all private bedrooms with one clients per. LPA upon entry observed a check in station in the main entry of the facility. Facility is taking temperatures daily and documenting the results. LPA observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply in attached garage. Facility was observed to have supply of PPE. LPA toured the outside of the facility and observed a seating area for the resident’s enjoyment. LPA was informed that clients have been scheduled to receive the covid booster shot. The facility has completed the LIC808 Mitigation Plan and it was approved by the Department on July 26, 2021.

Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the facility representative and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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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