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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004460
Report Date: 04/19/2023
Date Signed: 04/19/2023 02:33:40 PM

Document Has Been Signed on 04/19/2023 02:33 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 & INLAND A/SC, 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: 5DATE:
04/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Ronald Manalad, Administrator (via telephone)TIME COMPLETED:
02:45 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit to the facility for the purpose of conducting a case management visit in order to deliver two Technical Assistance Advisory Notes based on observations made during the investigation of complaint reference #22-AS-20230414141352.

During the visit, LPA observed that at least three separate smoke detectors were beeping intermittently due to low batteries. The issue was pointed out to caregiving staff who states that the batteries would be replaced shortly. An advisory note on the licensee's obligation to ensure the facility remains in a state of good repair is being issued during the visit.

Additionally, clutter is observed on the East side of the physical plant. The area is not used as an egress route, but licensee is also provided consultation on the obligation to maintain the facility free of accumulated waste.

An exit interview was conducted via telephone and a copy of this report and advisory notes were provided to facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2023
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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