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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003953
Report Date: 12/13/2022
Date Signed: 12/13/2022 03:54:32 PM


Document Has Been Signed on 12/13/2022 03:54 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: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: 3DATE:
12/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mariana CorchesTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Jessica Cho arrived at Nohl Ranch Elderly Care III to conduct an unannounced Required 1 Year Inspection with an emphasis on Infection Control. At 2:35pm, LPA Cho was greeted and granted entry by Caregiver Raquel Guevara followed by Administrator Mariana Corches. LPA completed the Coronavirus 2019 (COVID-19) screening procedure upon entry. There are no active COVID-19 cases as of today. LPA observed a thermometer at the check-in station and the required COVID-19 precautionary signs posted on the entrance door and throughout the facility. Approximately 2:48pm, LPA began the tour with Administrator Corches. There are a total of six resident bedrooms and five resident bathrooms. There is one private staff bedroom. LPA checked the resident bedrooms. The resident bedrooms had the required furnishings. The resident bathrooms were checked. The toilets worked properly, showers were free of mold/mildew, grab bars were secure, slip mats were in place, and bathrooms were adequately stocked with hand soaps and paper towels. Hand washing signs were observed in the bathrooms. The hot water temperature in the resident bathrooms measured at 106.5 degrees Fahrenheit in Bathroom #1, 108.6 degrees Fahrenheit in Bathroom #2, 110.3 degrees Fahrenheit in Bathroom #3, 109.4 degrees Fahrenheit in Bathroom #4, and 108.8 degrees Fahrenheit in Bathroom #5. Perishable and non-perishable food supplies were checked and adequately stocked at the time of the visit. Smoke/carbon monoxide detectors and auditory devices were tested and operational. Medications, toxins, and sharps were locked and inaccessible to the residents. LPA Cho toured the outside grounds. There was shading and sufficient seating for residents. The exit gate was not self-closing and self-latching. LPA observed sufficient supply of emergency food/water and PPEs.

Based on the observations made during today's visit, no deficiency is being cited as per Title 22 Division 6 Chapter 2 of the California Code of Regulations. Advisory Notes (LIC9102s) were issued during the visit. An exit interview was conducted with Administrator Mariana Corches, and a copy of this report was provided during this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022
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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