306004477-10-24-2024-22-AS-ARJR-DACUKX-20241024153952

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004477
Report Date: 10/24/2024
Date Signed: 10/24/2024 03:40:05 PM

Document Has Been Signed on 10/24/2024 03:40 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 COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	WALTER'S RESIDENTIAL CARE		FACILITY NUMBER:	306004477
ADMINISTRATOR/ DIRECTOR:	KARRY VALLEJO		FACILITY TYPE:	735
ADDRESS:	2031 S. ARTESIA STREET		TELEPHONE:	(714) 831-1334
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY: 4		CENSUS: 4	DATE:	10/24/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:02 PM
MET WITH:	Rey Inarin-Administrator		TIME VISIT/ INSPECTION COMPLETED:	03:55 PM

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Administrator (AD) Rey Inarin.

For today’s visit, LPA observed a total of three clients in care and two staff members on duty.

LPA observed the Administrator's Certificate for facility AD Rey Inarin which expires on November 28, 2025.

LPA Ramirez toured the interior and exterior portions of the facility with AD Inarin. The facility is a one-story home and is licensed for four ambulatory clients. There are a total of five bedrooms of which four are client bedrooms and one for staff. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. LPA observed all windows were screened. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of two restrooms. Restrooms were observed to be in good repair and toilets were operational. Water temperature tested between 105.9-107.9 degrees Fahrenheit.

During today's visit LPA observed as clients were exercising by using the treadmill.

Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Fire extinguisher was observed to be fully charged and mounted by the dining room. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable.

CONTINUED ON LIC809-C..

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WALTER'S RESIDENTIAL CARE	FACILITY NUMBER: 306004477
	VISIT DATE: 10/24/2024

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LPA Ramirez observed the emergency disaster and evacuation plan, which is located by dining room. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to clients in care.

For the exterior portion, LPA Ramirez observed a shaded area, patio furniture, and the grounds were free of any hazards. There are two gates in the backyard which are self-closing and self-latching. No bodies of water were observed.

LPA reviewed three client files and four staff files. LPA also reviewed client money and ledger for four of four clients. LPA interviewed three clients and two staff.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Inarin.

A copy of this report was provided at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC809 (FAS) - (06/04)

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