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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004633
Report Date: 11/20/2023
Date Signed: 11/20/2023 12:44:51 PM

Document Has Been Signed on 11/20/2023 12:44 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:BC CARE HOMEFACILITY NUMBER:
306004633
ADMINISTRATOR:BUJA CHANGFACILITY TYPE:
735
ADDRESS:1351 VALWOOD STREETTELEPHONE:
(657) 248-7059
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 6CENSUS: 4DATE:
11/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Buja Change - AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived for an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry by Administrator Buja Chang.

The facility is a one-story home with four resident bedrooms, two bathrooms, kitchen, dining room, living room, medication/file room, staff room, back yard and attached two-car garage. Facility appeared clean, sanitary and well-organized. All resident rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and air dryers. Hot water measured at 115.6 degrees Fahrenheit in the bathroom accessible from the hallway and 113.9 degrees Fahrenheit in the bathroom located inside one of the rooms. Administrator had to adjust the hot water heater to ensure the water temperatures were in compliance. LPA advised that the facility staff monitor the water temperature to ensure it remains in compliance. Facility has a supply of extra linen stored in the medication/file room. LPA observed additional canned foods and activity supplies are also stored in the medication/file room. LPA observed exit gate in the backyard to be operational and unobstructed. Facility has two shaded seating areas in the backyard. Smoke and Carbon Monoxide detectors tested operational. LPA observed facility has emergency food and water supply. Laundry machines are stored in the garage and operational. Facility has a 2-day supply of perishable food and a 7-day supply of non-perishable food. Fire Extinguisher was observed to be fully charged as indicated by the built-in meter. The service tag indicates it was last serviced on 12/06/22. LPA reviewed medication and files for two out of the four clients. LPA reviewed three staff files. Medication and files are stored in a locked cabinet in the medication/file room. LPA observed all clients to be away at day program at time of inspection.

No deficiencies were noted during today's visit. An exit interview was conducted and a copy of this report was provided to the administrator.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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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