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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004750
Report Date: 06/18/2024
Date Signed: 06/18/2024 10:40:23 AM


Document Has Been Signed on 06/18/2024 10:40 AM - 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:EASTWOOD CARE HOMEFACILITY NUMBER:
306004750
ADMINISTRATOR:ANNA MALLARIFACILITY TYPE:
740
ADDRESS:8426 CHOPIN DRIVETELEPHONE:
(714) 735-9004
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:6CENSUS: 6DATE:
06/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Direct Service Providers,Paulo Faeldo, Celia Salalac and Adian NgoTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by staff. LPA met with Direct Service Providers (DSPs) Paulo Faeldo, Celia Salalac and Adian Ngo.

The facility is a one-story home with four resident bedrooms, two bathrooms, kitchen, dining room, living room, activity room, backyard and attached 2-car garage. Facility appears clean, safe and sanitary. LPA noted residents were away at day program.

All resident rooms had required elements, including bed, chair, closet space and ample lighting. Facility has extra linens and hygiene supplies for clients in the hallway closet. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured between 105 and 120 degrees F in both bathrooms. LPA observed facility has emergency food and water supply. LPA observed the fire extinguisher was last serviced on May 14, 2024. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in the kitchen and the garage. Knives are locked up separate from toxic chemicals. Medication for each client is kept locked in a closet near the entryway. The backyard has a shaded sitting/lounging area. Exit gate is unlocked and self latching. LPA observed exit gate to be unobstructed. LPA reviewed three resident files and three staff files. LPA also reviewed medication and P&I for three clients. LPA interviewed one staff. Resident were away from the facility at the time of the inspection and unable to be interviewed. Facility has board games, exercise equipment, electronics, music and more for resident use.

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

SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024
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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