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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004663
Report Date: 02/14/2022
Date Signed: 02/14/2022 03:52:51 PM

Document Has Been Signed on 02/14/2022 03:52 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:PUNZALAN HOMESFACILITY NUMBER:
306004663
ADMINISTRATOR:EDGARDO PUNZALANFACILITY TYPE:
735
ADDRESS:719 ROANNE STREET, N.TELEPHONE:
(714) 220-2528
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 5DATE:
02/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:51 PM
MET WITH:Belinda SimonTIME COMPLETED:
04:17 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was screened for Covid-19 symptoms and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. The facility is a single story home with 6 bedrooms, 2 bathrooms, living room, dining room and kitchen and a two car attached garage. LPA observed the client rooms had the required furnishings and all beds had clean linens. Each client has their own room. One bedroom is vacant. Hot water in both bathrooms measured 109 degrees Fahrenheit. Both bathrooms were clean and operational. LPA observed the kitchen is clean and organized. The knives are kept locked under the sink. Medication is kept locked in kitchen cabinets. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. LPA inspected the first aid kit. First aid kit had all the required elements. All smoke detectors and carbon monoxide detectors tested operational. The fire extinguisher is charged. LPA and staff toured the backyard. LPA observed a covered patio area with a seating area for clients. No bodies of water observed. LPA observed the exit gate on the kitchen side of the facility has a broken latch, the gate opens and closes but the latch is not operating. The exit gate on the other end of the facility is operational. LPA observed on the side of the house (kitchen side) the exit pathway had 2 ladders next to the fence. No files reviewed during the inspection. LPA and staff toured the garage. The garage is kept secured and off limits to clients. The garage is used for storage and has extra food in the spare refrigerator. Facility has a mitigation plan that is pending review. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2022
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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