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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004530
Report Date: 03/08/2024
Date Signed: 03/08/2024 10:33:13 AM

Document Has Been Signed on 03/08/2024 10:33 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:PRIME CARE MANORFACILITY NUMBER:
306004530
ADMINISTRATOR:ABDOL ARASTOOFACILITY TYPE:
735
ADDRESS:8592 LAMPSON AVENUETELEPHONE:
(714) 534-4457
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 26CENSUS: 25DATE:
03/08/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Abdol ArastooTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting health and safety checks. LPA met with Administrator (AD) Abdol Arastoo and explained the purpose of the inspection.

LPA and AD conducted a tour of the inside and outside of the facility. The facility consists of two separate buildings. Both buildings are single-story. Building A houses five client rooms, three bathrooms, kitchen, dining room and staff office. Building B houses eight client rooms, three bathrooms and laundry area. LPA observed all client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. Water temperature tested between 105-110 degrees Fahrenheit; faucets and toilets were operational. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Sharps, all and any toxic chemicals are inaccessible to clients in care. Fire extinguishers were charged, mounted, and located in multiple areas of the facility with tags indicating last inspection date of 3/08/23. Facility has a shaded seating area in the front entrance courtyard and in the backyard, no obstacles or hazards were observed.

LPA did not observe any immediate threats to the health or safety of clients in care and no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted and a copy of this report was provided to the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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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