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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003850
Report Date: 10/14/2022
Date Signed: 10/14/2022 01:55:58 PM


Document Has Been Signed on 10/14/2022 01:55 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:WHISPERING OAKS - WAVERLYFACILITY NUMBER:
306003850
ADMINISTRATOR:IMELDA C. CAROFACILITY TYPE:
740
ADDRESS:14782 WAVERLY LANETELEPHONE:
(714) 931-1945
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:6CENSUS: 4DATE:
10/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Marits Meres- Caregiver, Imedla Caro- Administrator TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into the facility by Caregiver Marites Meres and explained the reason for the visit. Administrator Imelda Caro arrived at 12:45PM

At 12:45 PM, LPA toured the facility with Administrator Imelda Caro. Facility is 6 bedrooms, 3 bathroom, one story home with an attached garage. Facility has 4 residents present during today's visit. LPA observed a screening and sanitizing station at entrance of the facility. LPA observed residents relaxing in their room and living room. Facility appears clean and sanitary. All resident rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and paper towels and have hand washing postings. Facility has 2 refrigerators with 7 day non-perishables and 2 day perishables. LPA observed facility has 72-Hour emergency food and water supply. Facility has a secured location for resident medication and files. LPA toured the outside grounds and observed outside visitation area. Exit gates are unlocked and self latching. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. LPA reviewed all residents’ files and all contained required documentation including updated emergency information. All staff and residents are vaccinated for COVID 19.

No deficiencies were noted during today's visit. This report was discussed with the facility representative and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
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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