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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004275
Report Date: 01/16/2025
Date Signed: 01/16/2025 03:39:19 PM

Document Has Been Signed on 01/16/2025 03:39 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:CHEERFUL HEART HOME VFACILITY NUMBER:
306004275
ADMINISTRATOR/
DIRECTOR:		ANA SANDRUFACILITY TYPE:
740
ADDRESS:10722 ALBANY CIRCLETELEPHONE:
(714) 726-6525
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Ana SandrusTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA), Samer Haddadin made an unannounced visit to the facility to conduct a Required - 1 year visit. LPA was greeted and granted entry to the facility by care staff. Administrator (AD) Ana Sandru was notified by the caregivers of the visit who arrived shortly after LPA arrival.

LPA conducted a tour of the facility inside and out of physical plant and observed the following:
The facility is a single-story home with seven bedrooms and 4 restrooms. One out of the 7 bedrooms is designated for staff and 6 out the 7 bedrooms are for the current residents. At the time of the visit the facility had 2 staff members on duty and 6 residents total, in which 2 of the 6 residents were in the hospital.

LPA and S1 tested smoke detectors/carbon monoxide in common areas and bedrooms; all were operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably.
LPAs observed fire extinguisher mounted in kitchen area with a purchase date of January 16th, 2025. Upon review of record, fire drill was conducted on November 12th, 2024. LPA observed sharps and knives were secured and locked in kitchen drawer.
The facility had 2-day supply of perishable and 7-day supply of non-perishable foods and water. LPA observed all Kitchen appliances were operational during today's visit.

Restrooms toilets and water faucets were also observed to be operational. Grab bars were secure, and showers were observed to be free of mold/mildew. Water temperature measured between at 111.6 degrees Fahrenheit and 112. degrees Fahrenheit.

LPAs and AD toured the backyard of the facility and observed a shaded seating area for residents’ enjoyment.

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Alisa OrtizTELEPHONE: (714) 703-2855
Samer HaddadinTELEPHONE: (714) 790-2096
DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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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: CHEERFUL HEART HOME V
FACILITY NUMBER: 306004275
VISIT DATE: 01/16/2025
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LPAs reviewed three residents’ and three staff files and observed they all had the required documentation.

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 provided to staff at end of inspection
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Samer HaddadinTELEPHONE: (714) 790-2096
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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