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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003933
Report Date: 12/28/2023
Date Signed: 12/28/2023 12:20:25 PM

Document Has Been Signed on 12/28/2023 12:20 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:CHATEAU ST. MARK HOMES 1FACILITY NUMBER:
306003933
ADMINISTRATOR:ANICIA LOPEZFACILITY TYPE:
735
ADDRESS:9671 RANDOM DRIVETELEPHONE:
(714) 635-7732
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 5DATE:
12/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Julie Hilahan, Merlinda MaglayaTIME COMPLETED:
12:35 PM
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This unannounced Case Management – Other inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of a following up on renovations recently completed at the facility. LPA met with Staff #1 (S1) Julie Hilahan and Staff #2 (S2) Merlinda Maglaya and discussed the purpose of the inspection. Administrator (AD) Martin Lopez appeared via telephone. During the Required – 1 Year inspection conducted on 10/03/23, LPA observed the facility to be vacant with extensive renovations taking place at the facility. Per S1, the renovations were completed and the clients moved back into the facility on 12/11/23. During today’s inspection, LPA reviewed Infection Control requirements. At about 11:00AM, LPA and S2 conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, and garage and observed the following: Structure: facility is a 7-bedroom, 2-bathroom, one-story house with a detached garage that is being used for storage. There is a back yard with a patio cover for the clients. LPA observed 2 staff and no clients present at the facility. Client Bedrooms: the 5 client bedrooms are spacious and will easily accommodate the clients’ furnishings. Furniture for each client bedroom inspected. Staff Bedrooms: the 2 staff bedrooms are locked. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 106.1 and 108.5 degrees F in the common client bathrooms. LPA inspected all rooms in the facility. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the cleaning closet. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 11:45AM, LPA reviewed 5 client files and 2 staff files, inspected medications for 5 clients, and inspected client money and ledgers for 5 clients. There were no deficiencies 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.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2023
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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