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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003860
Report Date: 02/14/2023
Date Signed: 02/14/2023 12:04:26 PM

Document Has Been Signed on 02/14/2023 12:04 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ELIZABETH HOMES/NEPTUNE DRIVEFACILITY NUMBER:
306003860
ADMINISTRATOR:ELIZABETH SANTOSFACILITY TYPE:
735
ADDRESS:8439 NEPTUNE DRIVETELEPHONE:
(714) 821-8651
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
02/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Maxine Kniazeff, Asst. AdministratorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by direct care staff and explained the nature of the visit. Maxine Kniazeff, Assistant Administrator arrived shortly after and met with LPA.

LPA Martinez began the tour of the inside and outside of the facility. There are six clients in care and no active covid cases in the facility. Upon entry LPA observed one client in the dinning room and was informed there were clients out in the community. Clients observed to be clean and well taken care of. There is a sign-in procedure in place and hand sanitizer for use. LPA was checked in with temperature check and was logged in. LPA observed required department postings, covid precautionary postings, and hand washing sign posted in the facility. LPA observed the Emergency Disaster Plan posted and the facility has a Mitigation Plan on file with the department. There is a minimum of one week non-perishable foods and two day of perishable foods available. The facility has an emergency food and water supply. The facility is equipped with hygiene, cleaning and disinfecting supplies. Personal protective equipment (PPE) supply is available for use at the facility. All bathrooms observed to have a supply of soap, toilet paper and paper towels for use. LPA toured the client’s bedrooms and observed all bedrooms to have all required components. Facility has a secure location for client’s medication and LPA observed the facility to have a 30 day supply of medication on hand. Facility observed to be clean and sanitary at the time of inspection. LPA toured the outside of the facility and observed a shaded seating are for client’s use.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the facility representative and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
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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