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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306003842
Report Date:
11/04/2021
Date Signed:
11/04/2021 03:36:36 PM
Document Has Been Signed on
11/04/2021 03:36 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:
GILBERT CARE HOME-MILAN
FACILITY NUMBER:
306003842
ADMINISTRATOR:
ROSANNA MAGKAWAS
FACILITY TYPE:
735
ADDRESS:
322 N. MILAN PLACE
TELEPHONE:
(714) 484-1880
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92801
CAPACITY:
6
CENSUS:
5
DATE:
11/04/2021
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
02:40 PM
MET WITH:
Melania David, Arnold Andal, Noel Villegas
TIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a case management visit. LPA was greeted and granted entry by the staff. LPA explained the reason for the visit. The Agency (CCL) received a report from the facility that a client (C1) had eloped from the facility. LPA met the clients of the facility and toured the facility. LPA observed the facility has a 2 day perishable and 7 day non-perishable food supply on hand. LPA did not observe any obstacles or hazards at the facility. When the client eloped the staff followed the client and brought her back to the facility. Staff contacted the Administrator and the Administrator reported the incident to the Regional Center and Community Care Licensing (CCL). The responsible party and the client's doctor were notified also. Administrator Arnold Andal arrived at 3:10 pm. Noel Villegas arrived at 3:25 pm. LPA observed 4 staff were at the facility during the visit. LPA consulted with the Administrator concerning reporting requirements and continuing to work with the all concerned parties regarding minimizing future elopements. No deficiencies are being cited as a result of this visit. An exit interviewed conducted and a copy of this report provided.
SUPERVISORS NAME
:
Luz Adams
LICENSING EVALUATOR NAME
:
Joseph Alejandre
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/04/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/04/2021
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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