<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003871
Report Date: 03/22/2022
Date Signed: 03/22/2022 02:40:28 PM


Document Has Been Signed on 03/22/2022 02:40 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:ARCENE GUEST HOME #1FACILITY NUMBER:
306003871
ADMINISTRATOR:MAILA ENRIQUEZ-SOLIVENFACILITY TYPE:
740
ADDRESS:400 EVE CIRCLETELEPHONE:
(714) 491-0822
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 0DATE:
03/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:19 PM
MET WITH:Brady Post, Maila Enriquez-SolivenTIME COMPLETED:
02:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting an Annual Inspection. LPA met with facility Staff #1 (S1) Brady Post and discussed the purpose of the inspection. During the inspection, Administrator (AD) Maila Enriquez-Soliven appeared via telephone. The facility is still operating, but is currently empty for renovation. During the inspection, LPA and S1 conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following:

During the inspection, LPA and S1 observed there was 1 staff present. LPA observed 0 residents were present. LPA inspected common areas, resident rooms, kitchen, and garage and observed they were clean and organized and currently being renovated, and found no health and safety issues. AD stated that the facility furniture will be returned to its original state once the renovation has been completed. AD stated that the facility will have a 2-day supply of perishables and a 7-day supply of non-perishable food once the renovation has been completed. AD stated that the hallways and walkways will be free of obstruction once the renovation is completed.

LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, staffing, infection control/lead/training, PPE, staffing and staffing shortages, communication and emergency plan, and dementia. LPA provided technical assistance regarding Guardian and N95 fit testing.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1