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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003810
Report Date: 12/03/2024
Date Signed: 12/03/2024 11:12:08 AM

Document Has Been Signed on 12/03/2024 11:12 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/
DIRECTOR:		CAROL ODULIOFACILITY TYPE:
735
ADDRESS:11232 LOARA STREETTELEPHONE:
(714) 537-8045
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 6CENSUS: 6DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:40 AM
MET WITH:Muriel LapinedTIME VISIT/
INSPECTION COMPLETED:
11:26 AM
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This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and Eboni Bentley for the purpose of conducting a Required – 1 Year Inspection. LPAs met with Staff #1 (S1) Muriel Lapined and discussed the purpose of the inspection. Administrator (AD) Carol Odulio was not present during the inspection.

LPAs reviewed Infection Control requirements. At about 8:00AM, LPAs and S1 conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, and garage and observed the following: Structure: facility is a 7-bedroom, 7-bathroom, one-story house with an attached garage that is used for storage. One bedroom and one bathroom are being used for staff. There is a back yard with seating and an umbrella covering for the clients. LPAs observed 2 staff and 6 client present at the facility and spoke to Administrator by phone. Client Bedrooms: the 6 client bedrooms are spacious and will easily accommodate the clients’ furnishings. Furniture for each client bedroom inspected. Staff Bedroom: LPAs inspected the one staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 119 and 120 degrees F in the 6 client bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the laundry room. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 9:00AM, LPAs reviewed 6 client files and 4 staff files, interviewed 2 clients and 1 staff, inspected medications for 6 clients, and inspected client money and ledgers for 6 clients.

CONTINUED
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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 12/03/2024 11:12 AM - It Cannot Be Edited


Created By: Sean Haddad On 12/03/2024 at 10:54 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: STARLIGHT GUEST HOME
FACILITY NUMBER: 306003810

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85064(k)
Administrator Qualifications and Duties
(k) Within six months of becoming an administrator, the individual shall receive training on HIV and TB required by Health and Safety Code Section 1562.5. Thereafter, the administrator shall receive updated training every two years.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on documents, the administrator has not completed the 3 hour HIV and 1 hour TB training within the last 2 years, which poses a potential health risk to persons in care.
POC Due Date: 12/31/2024
Plan of Correction
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Licensee stated they will have the administrator complete the required HIV/TB training and submit proof to LPA by POC due date.
Type B
Section Cited
CCR
80068(a)
Admission Agreements
(a) The licensee shall complete an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on documents, the licensee did not ensure 6 out of 6 clients had signed the licensee's admission agreement, which poses a potential personal rights risk to persons in care.
POC Due Date: 12/31/2024
Plan of Correction
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Licensee stated they will have all clients sign the admission agreement and submit proof to LPA by POC due date.
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:Armando J Lucero
LICENSING EVALUATOR NAME:Sean Haddad
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME
FACILITY NUMBER: 306003810
VISIT DATE: 12/03/2024
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During the inspection, LPAs and S1 observed the following: based on documents, the administrator has not completed the 3 hour HIV and 1 hour TB training within the last 2 years; based on documents, the licensee did not ensure 6 out of 6 clients had signed the licensee's admission agreement.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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