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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004509
Report Date: 02/06/2025
Date Signed: 02/06/2025 11:08:34 AM

Document Has Been Signed on 02/06/2025 11:08 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:BONAFIDE HOME CAREFACILITY NUMBER:
306004509
ADMINISTRATOR/
DIRECTOR:		ERLEEN B. RINEHARTFACILITY TYPE:
740
ADDRESS:25215 ROMERA PL.TELEPHONE:
(949) 306-1521
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
02/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Erleen Rinehart- Administrator
Arcely Santos- Caregiver 		TIME VISIT/
INSPECTION COMPLETED:
11:23 AM
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On February 6, 2025 at 8:40 am, Licensing Program Analyst (LPA) Nancy Guillen conducted an unannounced Case Management Visit to follow up on Plan of Corrections (POC) cited on January 22, 2025. LPA was greeted and granted entry by caregiver Markjaydar Romuar and explained the reason for the visit. Caregiver called Administrator (AD) Erleen Rinehart over the phone and AD arrived shortly after.

LPA and caregiver Arecely Santos toured the physical plant and made the following observations.

Deficiencies cited under Title 22 Regulation California Codes 87309(a) and 87309(a)(1) pertaining to the
disinfectants and cleaning solutions being inaccessible to residents and kept separate from food supplies has been cleared. Knives and kitchen supplies were observed in a separate cabinet in the kitchen away from toxins and no other poisonous substances were observed accessible to residents.

Deficiencies cited under Title 22 Regulation California Codes 87465(h)(2) and 87465(h)(5) pertaining to medications being accessible to residents in an unlocked staff bedroom and medications being transferred into a separate container has been cleared. LPA observed the staff bedroom to be locked and no other medications were observed accessible at the facility. LPA observed no medications being transferred into separate containers.

Deficiencies cited under Title 22 Regulation California Codes 1569.311 pertaining to an inoperable carbon monoxide detector has been cleared. Carbon monoxide was replaced and observed operational at the time of visit.

Continued on LIC809C
Armando J LuceroTELEPHONE: (714) 703-2866
Nancy GuillenTELEPHONE: (714) 724-3542
DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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: BONAFIDE HOME CARE
FACILITY NUMBER: 306004509
VISIT DATE: 02/06/2025
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LPA was unable to clear deficiencies for CCR 87412(a) pertaining to missing staff records and CCR 1569.695(c) pertaining to the outdoors being free of obstructions and hazards. AD was unable to provide staff files. AD stated staff records were inaccessible in the garage. LPA informed AD staff records must be readily available for review. LPA also observed the outdoor passageways were not clear of obstruction and sharp gardening tools accessible to residents (photos taken). AD stated that she has been sick and unable to complete the mentioned deficiencies. AD requested an extension during the visit. LPA informed AD that extensions are to be requested before the POC due date.LPA extended the POC due date until February 21, 2025. LPA requested the outdoor hazards be removed during the visit and LPA confirmed the hazards were removed before leaving the facility. AD was informed a second visit will be conducted to verify Plan of corrections and to verify the backyard continues to be free of hazards.

An exit interview was conducted and a copy of this report and three POC letters were left at the facility.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2866
LICENSING EVALUATOR NAME: Nancy GuillenTELEPHONE: (714) 724-3542
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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