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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003810
Report Date: 10/31/2023
Date Signed: 10/31/2023 03:15:42 PM

Document Has Been Signed on 10/31/2023 03:15 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
ORANGE COUNTY ASC, 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:
10/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:24 PM
MET WITH:Muriel Lapined - CaregiverTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived for an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by Caregiver Muriel Lapined. Administrator Carol Coltharp joined the inspection via phone call throughout the visit.

The facility is a one-story home with six client bedrooms, six bathrooms, kitchen, dining room, living room, one staff room, pantry, laundry room, backyard, patio and attached two car garage. Facility appears clean and sanitary. All resident rooms had required elements, including bed, chair, closet space and ample lighting. The restrooms are stocked with paper towels, soap and hand washing posters. Hot water in all bathrooms measured between 107.2 degrees Fahrenheit and 119.2 degrees Fahrenheit. LPA observed facility has emergency food and water supply. Facility has a shaded seating area in the backyard and plenty of room to walk around if clients want. LPA observed some unused wooden items/furniture in the backyard. Facility has already requested pickup for these items. The ramps in the backyard are in slight disrepair. Two of the railings are leaning and three vertical posts have come loose. Facility has already had someone come out to assess the ramps and they will be returning to repair them. The exit gates are unlocked and self-latching. LPA observed the fire extinguishers to be fully charged. Service tags indicate the extinguishers were last serviced on 07/10/2023. Facility has several activity supplies including but not limited to puzzles, coloring books, board games, and electronics. The staff also mentioned the facility is having a Halloween party later on for the residents to participate in. Medication for each resident is kept in locked cabinets in the kitchen. LPA reviewed three of six resident files. LPA reviewed two clients’ medication. LPA reviewed three staff files. LPA interviewed 3 clients.

Based on today’s inspection, no deficiencies are being issued. An exit interview was conducted and a copy of this report was provided to the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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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