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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004655
Report Date: 04/11/2024
Date Signed: 04/11/2024 04:31:37 PM


Document Has Been Signed on 04/11/2024 04:31 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:LAS ESTANCIAS ASSISTED CAREFACILITY NUMBER:
306004655
ADMINISTRATOR:CELIA RODRIGUEZFACILITY TYPE:
740
ADDRESS:1409 WHITTIER AVENUETELEPHONE:
(714) 488-9995
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:6CENSUS: 6DATE:
04/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:36 PM
MET WITH:Facility Administrator - Celia RodriguezTIME COMPLETED:
04:45 PM
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Licensing Program Analysts (LPA) Celine De Perio and Faith La conducted an unannounced required annual inspection. LPA De Perio explained reason for visit and was greeted and granted entry by facility administrator (AD) Celia Rodriguez. The PUB475 "See Something, Say Something" poster was observed to be posted in the kitchen. LPAs observed the Administrator's Certificate for Cecila Rodriguez, which expires on 7/19/24.

LPAs toured the interior and exterior portions of the facility with AD Rodriguez. The facility is a single level structure and is licensed for 6 non-ambulatory, 1 bedridden and 3 hospice. For this visit, there are 0 residents on hospice and 0 bedridden. There are a total of 5 bedrooms, of which 4 are private resident rooms and 1 shared resident room. LPAs toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 3 restrooms of which were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 110.4 degrees Fahrenheit.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen.



LPAs observed the emergency disaster and evacuation plan, which is posted in the kitchen. Facility had back-up emergency food and water supply, located in the kitchen and in the garage. LPAs observed that First Aid Kit had all the required components. Medications and toxins were also observed to be locked and inaccessible to residents.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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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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: LAS ESTANCIAS ASSISTED CARE
FACILITY NUMBER: 306004655
VISIT DATE: 04/11/2024
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For the exterior portion, LPAs observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which were self-closing and self-latching. No bodies of water were observed.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

No citations were issued.

An exit interview was conducted with AD Rodriguez.

A copy of this report was explained, and provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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