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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004460
Report Date: 02/21/2025
Date Signed: 02/21/2025 10:36:42 AM

Document Has Been Signed on 02/21/2025 10:36 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:REAL HEARTS HOMEFACILITY NUMBER:
306004460
ADMINISTRATOR/
DIRECTOR:		EVELYN SCHAEFERFACILITY TYPE:
735
ADDRESS:2860 W.COOLIDGE AVENUETELEPHONE:
(714) 886-2076
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 5DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:07 AM
MET WITH:Charly CaolengTIME VISIT/
INSPECTION COMPLETED:
12:44 PM
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Licensing Program Analyst (LPA) Samer Haddadin made an unannounced visit for the purpose of completing an annual required inspection. LPA met with Staff (S1) Charly Caoleng and discussed the purpose of the inspection.
Five clients reside at this facility in which three were present and Two at day program.
facility is a 6-bedroom, 2-bathroom, one-story house with a detached garage that is being used for storage. LPA observed the medication cabinet unlocked and unsecured; staff immediately locked it and secured the cabinet.

LPA reviewed medication and observed medication was labeled and stored inaccessible to clients in care. LPA inspected the bathroom and LPA measured the hot water temperature which measured 108.6 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies.


LPA observed that toxic chemicals, cleaning solutions and disinfectants were NOT secured and were stored under the kitchen sink accessible to clients in care.
The facility has an available clean supply of linens. LPA inspected client’s bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for clients in their bedroom. Smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there is shaded seating areas for client’s enjoyment.
LPA observed required department postings posted on the wall of facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in the spare refrigerator and pantry located in garage.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: REAL HEARTS HOME
FACILITY NUMBER: 306004460
VISIT DATE: 02/21/2025
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LPA observed a fire extinguisher, last inspection date of Feb 5th, 2025, is in kitchen. Fire drills was conducted on Feb 2nd, 2025, and is being conducted quarterly.
LPA reviewed three clients’ records and three staff files; all the required documentations were present and current.

Based on the observation made during today’s visit, one deficiency was citied today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the facility representative, and a copy of this report and appeal rights were provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
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Document Has Been Signed on 02/21/2025 10:36 AM - It Cannot Be Edited


Created By: Samer Haddadin On 02/21/2025 at 10:23 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: REAL HEARTS HOME
FACILITY NUMBER: 306004460

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(k)(1)
Health-Related Services
(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation], the licensee did not comply with the section cited above in leaving the medication cabinet unlocked and accessible which poses an immediate health and safety to persons in care.
POC Due Date: 02/24/2025
Plan of Correction
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Staff locked the cabinet .
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alisa Ortiz
LICENSING EVALUATOR NAME:Samer Haddadin
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2025


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