306003953-12-17-2024-22-AS-WVAS-DC2S4W-20241217123325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306003953
Report Date: 12/17/2024
Date Signed: 12/17/2024 12:33:40 PM

Document Has Been Signed on 12/17/2024 12:33 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	NOHL RANCH ELDERLY CARE III		FACILITY NUMBER:	306003953
ADMINISTRATOR/ DIRECTOR:	GABE/MARIANA CORCHES		FACILITY TYPE:	740
ADDRESS:	2128 E. WHITE LANTERN LANE		TELEPHONE:	(714) 921-1336
CITY:	ORANGE	STATE: CA	ZIP CODE:	92867
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	12/17/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:19 AM
MET WITH:	Mariana Corches		TIME VISIT/ INSPECTION COMPLETED:	12:45 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	On 12/17/2024 at 8:10AM Licensing Program Analyst (LPA) William Vanegas and Licensing Program Manager (LPM) Alisa Ortiz made an unannounced visit for the purposes of a required annual inspection. Upon arrival LPA and LPM were greeted and granted entrance by caregiver Raquel Diaz. We identified ourselves and stated the purpose for our visit. Caregiver Raquel advised she would call the Administrator (AD) Mariana Corches and upon AD's arrival we began a tour of the facility at 8:16AM and observed the following. This is a two story home with five resident bedrooms and one staff bedroom it also has five bathrooms all which were in good repair and free of debris. Resident bathrooms were observed to have working toilets and running water faucets. Water tested to be from 103.4 degrees to 106.7 degrees. Resident showers were observed to have all the required materials such as grab bars, shower chair, and slip resistant mats. All resident bedrooms were observed to be in good repair and contained all the required furnishings such as a lamp, chest drawer, required storage space, a chair, a bed, and and operable lamp. Bed linens were in good repair, meaning no strains or tears. Upstairs living quarters are utilized for licensees family only. LPA Vanegas and LPM Ortiz observed kitchen area to be in clean and sanitary repair. Refrigerator and Freezer were in working condition and LPA and LPM observed there to be a 7 day supply of non-perishable food available and a 2 day supply of perishable food available for residents in care. LPA and LPM observed a sufficient amount of emergency water as well. Gas stove, microwave, and washer and dryer were all tested and observed to be operable. Medications were observed to be in a locked container and observed to be inaccessible to residents in care. AD does have a record of when medications were being administered, however, record is incomplete and does not retain all required information. A technical violation was issued on today's date. She is currently taking notes of when the medication was started and at what time it was opened, however there is no record of when the medication was taken. CONTINUED ON LIC809

Armando J Lucero	TELEPHONE: (714) 703-2866
William Vanegas	TELEPHONE: (714) 497-7621
	DATE: 12/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

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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Document Has Been Signed on 12/17/2024 12:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NOHL RANCH ELDERLY CARE III	FACILITY NUMBER: 306003953
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Other Provisions

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in two out of three staff members not completing the 20 hour annual training. S1 and S3 are missing annual training, which poses a potential health and safety risk to persons in care.
	POC Due Date: 12/31/2024
	Plan of Correction
1 2 3 4	Administrator will have S1 and S3 complete the required training and email proof of correction to LPA Vanegas by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Armando J Lucero	TELEPHONE: (714) 703-2866
William Vanegas	TELEPHONE: (714) 497-7621
	DATE: 12/17/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NOHL RANCH ELDERLY CARE III	FACILITY NUMBER: 306003953
	VISIT DATE: 12/17/2024

NARRATIVE

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All hazards are secured and inaccessible to residents in care. Fire extinguisher was observed to be up to date and fully charged. All smoke detectors and carbon monoxide detectors were tested and observed to be operational. Night lights were observed in the hallway leading to all common area bathrooms as well.

LPA Vanegas and LPM Ortiz observed the outside of the facility and observed all emergency exit routes to be free of obstructions and all exit doors are self latching and unlocked. There is a shaded outdoor seating area, and is big enough for residents in care to participate in outdoor activities. LPA and LPM observed garage and it is secured and inaccessible to residents in care. The garage contained tools and wheelchairs as well as a refrigerator for AD personal use. AD stores emergency water in the garage as well.

LPA Vanegas reviewed three resident records and they all had the required documents. LPA Vanegas also reviewed three staff records and two out of three staff records were missing the required 20 hour annual training.

Based on the observations made during today’s inspection, 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 and appeal rights were left at the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2866
LICENSING EVALUATOR NAME: William Vanegas	TELEPHONE: (714) 497-7621
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

LIC809 (FAS) - (06/04)

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