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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004566
Report Date: 03/01/2022
Date Signed: 03/01/2022 04:26:14 PM

Document Has Been Signed on 03/01/2022 04:26 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NEW HOPE CARE HOMESFACILITY NUMBER:
306004566
ADMINISTRATOR:ASUNCION JACINTOFACILITY TYPE:
735
ADDRESS:7284 CHEROKEE CIRCLETELEPHONE:
(714) 588-3112
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 5DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Administrator, Asuncion JacintoTIME COMPLETED:
04:30 PM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and was granted entry into the facility by Staff. LPA explained the reason for the visit.

During the visit Licensee Anil Suresh arrived at facility. LPA toured the facility with Administrator. Facility is a 7 bedroom (6 clients rooms, 1 staff) and 2 bathroom single story home. There are 5 Clients in care. LPA observed facility has required Department postings. LPA toured all clients rooms, all rooms where within regulations. All restrooms observed contained working water basin, soap, and toilet paper. Restrooms had proper hand washing signs posted. Water temperature recorded at 117.5 degrees Fahrenheit. Clients were observed relaxing in bedrooms and sitting in common areas. Facility has operating smoke detectors and carbon monoxide detectors.

Facility has PPE supply. Facility has 2 refrigerators and pantry with ample food supply. LPA observed facility has ample emergency food and water supply. Facility has 1 fire extinguisher which is fully charged. Facility has evacuation plan posted. Facility has a secured location for Client medication and files. Facility has 30 days supply of medications for clients. LPA reviewed 5 of 5 Clients files during visit. Clients emergency contact information and physicians reports are current. Facility has designated visitation area.

An exit interview was conducted with Licensee and copy of report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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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