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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004460
Report Date: 02/22/2022
Date Signed: 02/22/2022 03:12:34 PM

Document Has Been Signed on 02/22/2022 03:12 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:REAL HEARTS HOMEFACILITY NUMBER:
306004460
ADMINISTRATOR:EVELYN SCHAEFERFACILITY TYPE:
735
ADDRESS:2860 W.COOLIDGE AVENUETELEPHONE:
(714) 886-2076
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 6DATE:
02/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Charlie CaolengTIME COMPLETED:
03:26 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Staff called Administrator Evelyn Schaefer and informed her of the visit. LPA and staff toured the facility. LPA observed the paint in bedroom 1 is chipped/faded and the door knob for the closet is missing. LPA observed the door for bedroom 3 has been damaged and the holes have been repaired and the paint is chipped. LPA observed the wall in the hallway for the bedrooms has been repaired but not painted (it is white, the hallway is beige). LPA observed the client bedrooms had the required furnishings. All smoke/carbon monoxide detectors tested operational. Both bathrooms were clean and operational. Hot water temperature measured 112.4 degrees Fahrenheit in bathroom 1 and 109.4 degrees Fahrenheit in bathroom 2. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand in the kitchen. LPA observed knives are kept locked in a kitchen cabinet. LPA observed medication is kept locked in a closet. LPA and staff toured the garage. LPA observed the garage is kept locked and used for storage of supplies and extra food. LPA and staff toured the facility office. The facility office is kept locked and used for storage. The office has an extra room that is used to keep extra food. LPA toured the backyard. The backyard has a covered patio and a sitting area for the clients. The exit gate is operational. No bodies of water observed. No obstacles or hazards in the backyard. Facility has a mitigation plan that is pending approval. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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