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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003860
Report Date: 03/26/2024
Date Signed: 03/26/2024 11:47:59 AM

Document Has Been Signed on 03/26/2024 11:47 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: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: 4DATE:
03/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Maxine Kniazeff - Assistant AdministratorTIME COMPLETED:
11:55 AM
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Licensing Program Analysts (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Staff contacted Administrator Maxine (Maxima) Kniazeff who arrived a short time later and was present for the remainder of the of the visit.

During the inspection, LPA Haley observed all client bedrooms and bathrooms. All client bedrooms had the necessary elements and were in compliance with regulation guidelines.

Client bathrooms were clean and organized. Hot water temperatures were measured in the range of 105.2 degrees Fahrenheit and 107.7 degrees Fahrenheit. No hazardous items were observed in the client bathrooms, and all grab bars were tightly secured to the wall.

In the kitchen knives and sharp objects are kept locked in a drawer. Hazardous cleaning materials are kept locked under the sink. A perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the cabinets. There is a washer and dryer in between the kitchen and garage. Above the washer and dryer there is a locked cabinet with hazardous cleaning items.

The garage was organized and free of clutter. A lockedvcabinet with a supply of hygiene items was observed. In the middle of the garage exercise equipment (treadmill, exercise bike) was observed. There was a large supply of adult diapers stocked on the shelves and there was an additional refrigerator with an additional supply of non-perishable food items.

An emergency supply of water, latex gloves, surgical mask, and hygiene items was observed in a locked storage room. Client medications, a first aid kit, and Client P&I was locked in a cabinet. Above the locked cabinet with client medications and P&I funds, there's a cabinet with emergency bags for the clients.

Continued on LIC809C

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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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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: ELIZABETH HOMES/NEPTUNE DRIVE
FACILITY NUMBER: 306003860
VISIT DATE: 03/26/2024
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The backyard was clean, organized, and walkways were free of obstruction. A shaded patio area with tables and chairs was observed. There is a locked shed in the backyard used to store miscellaneous items and some paint. The side exit gate is self-closing and self-latching.

Smoke detectors, and the carbon monoxide detector tested operational. A fully charged fire extinguisher was observed mounted on the wall in the kitchen above the sink.

An emergency evacuation drill was conducted March 5, 2024 and will continue to be conducted quarterly for staff on each shift.

No deficiencies are being cited as a result of today’s visit.

An exit interview conducted, and a copy of this report was provided to Administrator Maxine Kniazeff.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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