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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004367
Report Date: 03/19/2024
Date Signed: 03/19/2024 04:47:57 PM

Document Has Been Signed on 03/19/2024 04:47 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:ARFEL CARE HOME 1FACILITY NUMBER:
306004367
ADMINISTRATOR:ARIEL WATINFACILITY TYPE:
735
ADDRESS:8881 PIERCE DRIVETELEPHONE:
(714) 827-7188
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 3DATE:
03/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Ariel Watin - Licensee/AdministratorTIME COMPLETED:
04:55 PM
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Licensing Program Analysts (LPAs) Jerome Haley, Edward Kim and Licensing Program Manager (LPM) Lourdes Montoya conducted an unannounced visit for the purpose of conducting a required one year annual inspection. LPA Haley, Kim and LPM Montoya were greeted and granted entry by staff and explained the reason for the visit. Administrator (AD) Ariel Watin's Administrator certificate was posted on the wall and expires January 17, 2025.

During the inspection, LPA Haley observed all resident bedrooms and bathrooms. All resident bedrooms had the necessary elements and were in compliance with regulation guidelines.

Client bathrooms were clean and organized. Hot water temperatures were measured in the range of 106.3 degrees Fahrenheit and 105.6 degrees Fahrenheit. No hazardous items were observed in the client bathrooms, and all grab bars were tightly secured to the wall.

In the kitchen knives and sharp objects are kept locked in a cabinet. Hazardous cleaning materials are kept locked under the sink. Client medications are kept locked in a cabinet above the dishwasher. All four burners on the stove were operational.

In the garage, LPA Haley observed an extra supply of COVID PPE items. A washer and dryer was observed and soaps and detergents are kept locked in a cabinet with additional hazardous cleaning items. An extra refrigerator was observed in the garage with a supply of perishable food supply that meets regulation requirements. Walkways were clear and free of obstruction.

The backyard was clean, organized, and walkways were free of obstruction. A shaded patio area with tables and chairs was observed. The side exit gate is self-closing and self-latching.

Continued on LIC809C

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ARFEL CARE HOME 1
FACILITY NUMBER: 306004367
VISIT DATE: 03/19/2024
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Smoke detectors tested operational and a fully charged fire extinguisher was observed mounted on the wall in the kitchen near the dining room.

An emergency evacuation drill was conducted January 16, 2024 and will continue to be conducted quarterly for staff on each shift.

No deficiencies are being cited as a result of today’s visit.

An exit interview conducted, and a copy of this report was provided to Licensee/Administrator Ariel Watin.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC809 (FAS) - (06/04)
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