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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003953
Report Date: 12/14/2021
Date Signed: 12/14/2021 11:09:35 AM

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:NOHL RANCH ELDERLY CARE IIIFACILITY NUMBER:
306003953
ADMINISTRATOR:GABE/MARIANA CORCHESFACILITY TYPE:
740
ADDRESS:2128 E. WHITE LANTERN LANETELEPHONE:
(714) 282-8807
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY:6CENSUS: 5DATE:
12/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Mariana Corches, AdministratorTIME COMPLETED:
11:18 AM
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Licensing Program Analysts (LPAs) Ruth Martinez and Kevin Saborit-Guasch conducted an unannounced visit for the purpose of conducting a required annual inspection. LPAs were greeted and granted entry into the facility by caregiver. LPAs met with Mariana Corche, Administrator and explained the nature of the visit.

LPAs accompanied by Administrators began the tour of the inside and outside of the facility. There are five residents in care and there are no active covid-19 cases in the facility. LPAs observed residents in their bedrooms relaxing. All resident appeared to be clean and well taken care of. LPAs observed required department postings, covid-19 precautionary postings in the facility as well as hand washing signs throughout the facility. All restrooms observed to have supply of soap and they appeared to be clean. LPAs inspected residents’ bedrooms and appeared to be clean and sanitary. All bedrooms were observed to have all required components. Residents bedrooms are four private and one shared bedroom. Facility has an empty room to be used as necessary. LPA observed a check in station in the main entry of the facility. Facility is taking temperatures daily and documenting the results. LPA observed the emergency disaster and evacuation plan. Facility has an emergency food and water supply located in kitchen and in attached garage. Facility has PPE supply stored in caregiver room and attached garage. LPAs toured the outside of the facility and observed a shaded seating area for resident’s enjoyment. Administrator advised LPAs that residents and staff have received their covid booster shot. The facility has completed the LIC808 Mitigation Plan, the Department approved the Mitigation plan on April 27, 2021.

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

This report was reviewed with Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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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