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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004332
Report Date: 08/31/2026
Date Signed: 08/31/2026 11:15:59 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/31/2026 11:15 AM - 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:CANDLEWOOD MANORFACILITY NUMBER:
306004332
ADMINISTRATOR/
DIRECTOR:		NORAJOY KINNEYFACILITY TYPE:
740
ADDRESS:15781 CANDLEWOOD STREETTELEPHONE:
(714) 531-4522
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 5CENSUS: 3DATE:
08/31/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Irish TacsuanTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Hanna Fuller made an unannounced visit to the facility to conduct the required annual inspection. LPA was unable to chose this option in drop down menu when choosing what type of visit is being conducted. LPA was greeted and granted entry by staff. LPA met with House Manager (HM) Irish Tacsuan and discussed the purpose of the visit.

The facility is a two story home with the downstairs being where facility operations are conducted. There are three resident bedrooms, two resident bathrooms, living room, dining room and attached garage. LPA toured the facility and observed the kitchen to have traces of bugs and living cockroaches in the drawers. LPA observed a two day perishable and seven day non perishable food supply on hand. LPA observed the centrally stored medication to be in a locked kitchen cabinet and made inaccessible. LPA observed the toxins and chemicals to be locked under the kitchen sink and made inaccessible. The knives and sharps were observed to be in a locked drawer by the stove and made inaccessible. A fire extinguisher was observed in the kitchen charged and with a service date of June 16th, 2026. LPA observed the resident bedrooms have all the required components and furnishings. LPA observed the bathrooms to have toilet paper, paper towels and grab bars. The water was tested between 104.5 and 129.2 degrees Fahrenheit. Toxins and chemicals were observed to be locked under the bathroom sinks and made inaccessible. LPA observed the backyard to be free of debris and obstructions with unlocked exit gates. A shaded outdoor seating area was observed for resident use. The garage is used as extra facility storage with an extra working freezer and fridge. LPA observed the emergency food and water supply to be stored in the garage. A completed first aid kit was observed to be in the facility. LPA toured the 2nd floor of the facility and observed all caregiver rooms to be inaccessible by a gate at the bottom of the stairs. LPA observed an operational carbon monoxide detector in the facility. Continue on LIC809C

Kevin Saborit-Guasch
Hanna Gough
DATE: 08/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/31/2026 11:15 AM - It Cannot Be Edited


Created By: Hanna Gough On 08/31/2026 at 10:25 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CANDLEWOOD MANOR
FACILITY NUMBER: 306004332

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/01/2026
Section Cited
CCR
87555(b)(27)

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87555(b)(27) General Food Service Requirements
All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.
This requirement was not met as evidence by:
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Licensee stated they will have staff clean the kitchen drawers and pantry, call a pest control company and send proof of treatment scheduled to LPA by POC due date. Licensee to send LPA invoice once treatment has been conducted with visit summary.
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LPA observed living bugs/cockroaches in the kitchen drawer which poses an immediate health, safety or personal rights risk to residents in care.
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Type A
09/01/2026
Section Cited
CCR87303(2)

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87303(2) Maintenance and Operation
... Hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
This requirement was not met as evidence by:
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Licensee stated they will adjust the water temperature and send proof to water within regulatory degrees to LPA by POC due date. If it is determined that a plumber needs to be called, licensee will send proof of date scheduled to LPA by POC due date.
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LPA tested the water in the residents restroom to be between 104.5 and 129.2 degrees Fahrenheit. This poses an immediate health and safety risk to residents in care.
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Licensee to conduct in service with staff on testing the water temperature by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM MANAGER:
Hanna Gough
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/31/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2026


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: CANDLEWOOD MANOR
FACILITY NUMBER: 306004332
VISIT DATE: 08/31/2026
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LPA reviewed resident and staff files and no discrepancies were observed. LPA reviewed resident medications and no discrepancies were observed. LPA reviewed the last emergency drill was conducted on July 28th 2026. All staff present are background cleared and associated to the facility.

Based on today’s inspection deficiencies are being noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with records reviewed, LIC809D and appeal rights were left at the facility.

NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: Hanna Gough
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2026
LIC809 (FAS) - (06/04)
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