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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003897
Report Date: 05/04/2022
Date Signed: 05/04/2022 01:47:38 PM

Document Has Been Signed on 05/04/2022 01:47 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:PUNZALAN HOMES - STONYBROOKFACILITY NUMBER:
306003897
ADMINISTRATOR:ED/ERLINDA PUNZALANFACILITY TYPE:
735
ADDRESS:2785 W. STONYBROOK DRIVETELEPHONE:
(714) 821-4277
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 5DATE:
05/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Administrator Linda PunzalanTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPAs) Albert Marin and Celine De Perio made an unannounced required annual inspection to this facility. LPAs met with Administrator (AD) Linda Punzalan and stated the purpose of this visit.

The facility is single level structure licensed for capacity of six ambulatory of which one may be non-ambulatory. This facility is vendorized by the Regional Center of Orange County as a Level IV-I facility.

LPAs Marin and De Perio were granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. LPAs observed four clients and two staff members on the floor. One client was out attending day program. There were six private client's rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide, and auditory exit alarms were tested to be operational. Bathrooms were provided with handrails and nonskid floor mats. Hot water was measured at 113 degrees Fahrenheit. Medications, cleaning supplies and sharp kitchen items were inaccessible to clients in care. Facility met the minimum 2 day perishable and 7 day non- perishable food stock requirements. LPAs observed personal protective equipment in place. Fire extinguisher was mounted and charged. For the exterior portion, facility had outside furniture in good repair. Grounds were free of tripping hazards.

LPAs Marin and De Perio reviewed the COVID 19 mitigation plan of the facility. LPAs discussed Assembly Bill 665 that requires a licensee of any adult or senior care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that an support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. Administrator's certificate is valid until December 2, 2022.

No citation was issued during this visit.

LPAs Marin and De Perio conducted an exit interview with AD L Punzalan and copy of this report was left in the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
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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