<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004574
Report Date: 10/09/2023
Date Signed: 10/09/2023 04:09:57 PM

Document Has Been Signed on 10/09/2023 04:09 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:BREWSTER HOMEFACILITY NUMBER:
306004574
ADMINISTRATOR:EVELYN PASCUALFACILITY TYPE:
735
ADDRESS:1237 W. BREWSTER AVE.TELEPHONE:
(714) 535-3976
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 6DATE:
10/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:TIME COMPLETED:
04:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at Brewster Residential Care to conduct an unannounced Required 1 Year Inspection. LPA arrived at the facility at 1:00pm, and was greeted and granted entry by Administrators (ADs) Evelyn and Edguardo Pascual.

The facility is a one-story home with five resident bedrooms, two resident bathrooms, living room, kitchen, dining room, backyard, one staff bedroom, one staff bathroom and an attached one car garage. There are two exit gates on either side of the house. There is one shaded seating area in the backyard. LPA observed unused appliances in the backyard and garage. AD stated they are trying to donate items to another facility. LPA advised that they dispose of the unused items if they cannot secure a place to donate the items to before the end of the month. LPA did not observe these items to present immediate obstacles or hazards. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. Any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients and will be stored and locked in a cabinet in the kitchen and the garage. Medication, First-Aid Kit & Files are stored in a locked cabinet in the hallway. LPA reviewed three out of six client files and two staff files. LPA interviewed the three clients present. The fire extinguisher is fully charged. LPA observed service tag indicating the extinguisher was last serviced on 1/6/23. The facility does individual and group outings, including weekly bowling. Clients have personal items/electronics. The facility has three pets (two dogs and a fish). All bathrooms have working plumbing and designated hand washing posters. Hot water measured at 111.7 degrees Fahrenheit in the shared bathroom and 113.4 degrees Fahrenheit in the master bathroom. A supply of extra linen and hygiene supplies was stored in the hallway cabinet and garage. Emergency Phone Numbers, Exit Plan & Menu are all posted and available for review. There is a 2-day supply of perishable food and 7-day supply of non-perishable food on hand. Smoke detectors and carbon monoxide detector tested operational. Stove’s gas burner with oven, refrigerators, dish washer, microwave, washer and dryer are operational.
Based on the observations made during today's visit, no deficiencies are being cited as per Title 22 Division 6 Chapter 2 of the California Code of Regulations. An exit interview was conducted with Administrator Evelyn and Edguardo Pascual, and a copy of this report was provided.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1