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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003842
Report Date: 03/10/2022
Date Signed: 03/10/2022 12:56:43 PM

Document Has Been Signed on 03/10/2022 12:56 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-MILANFACILITY NUMBER:
306003842
ADMINISTRATOR:ROSANNA MAGKAWASFACILITY TYPE:
735
ADDRESS:322 N. MILAN PLACETELEPHONE:
(714) 484-1880
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 4DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:19 AM
MET WITH:Noel VillegasTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. Facility is a single story home with 7 bedrooms (1 is for staff), 2 bathrooms, living room with a fireplace, dining room. kitchen and a 2 car garage that is used for storage. All smoke detectors tested operational. The fireplace has been made inaccessible by a piece of wood that has been mounted to the bottom of the fireplace. Both bathrooms are clean and operational. Hot water measured 106.3 degrees Fahrenheit in both bathrooms. LPA observed all of the client rooms had the required furnishings. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. Knives are kept locked in a kitchen drawer. Detergents and soaps are kept locked under the kitchen sink. LPA and staff toured the backyard. The backyard is bisected by a fence. Staff reported that staff and clients do not use the other half of the backyard. The second half of the backyard is only accessible by the gate next to the garage. The gate is kept locked. LPA observed a plastic storage closet that was empty. LPA observed an empty pool and a shed and a small storage room on the side of the pool. LPA did not observe any hazardous items. LPA observed old furniture in the storage shed. The second half of the backyard that contains the empty pool is completed fenced off and kept locked and inaccessible to clients in care. The side of the backyard that is used by the facility has a covered patio that has a seating area for clients. The exit gate is operational. No bodies of water observed. No obstacles or hazards observed in the backyard. During the visit LPA observed 5 staff members working and 4 clients. During the visit Administrator Noel Villegas arrived. LPA inspected the First Aid Kit. The First Aid Kit had all the required elements. Facility has a mitigation plan that is pending approval. No deficiencies observed during the visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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