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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004778
Report Date: 07/18/2023
Date Signed: 07/20/2023 07:00:07 AM

Document Has Been Signed on 07/20/2023 07:00 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HEARTFELT CARE VILLAFACILITY NUMBER:
306004778
ADMINISTRATOR:IRENEO D. ALIPIO, JR.FACILITY TYPE:
735
ADDRESS:2440 W. BROADWAYTELEPHONE:
(714) 606-1087
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 3DATE:
07/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Davidson AlipioTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced Required - 1 year evaluation. LPA Martinez met and was granted entry by Staff Justine Volz and Violeta Quilao. Staff Davidson Alipio arrived to assist with visit. Administrator (AD) Divina Alipio was notified via telephone of LPA's presence at the facility. AD Divina has a current Administrator Certificate which expires on 11/02/2023.

LPA Martinez reviewed whether facility is operating within capacity limitations. Staff Volz reported census is 3. Clients were all present during this visit. Facility is a LeveI 4I, licensed for a capacity of 6. The facility is a 1 story home that consist of 6 bedrooms, of which 2 are occupied by staff, 3 bathrooms, living-room with dining room, kitchen, 2 car garage that is used for storage and laundry. The backyard has a patio cover and table and chairs for clients and visitors use. Facility has a gated pool which is inaccessible to the clients. Washer and dryer observed to be functional and operational. LPA, along with staff conducted a tour of the inside and outside of the facility; all passageways and other areas of potential hazard were inspected. Client bedrooms were observed to be spacious and easily accommodate furnishings such as lamps, chair, dresser and a bed. Bathrooms were clean, faucets, showers and toilets were operational. LPA observed plenty of hygiene items, such as soap, toilet paper, toothbrush, and toothpaste for the clients. The facility has a clean supply of linen and towels for each client in care. Hot water temperature in client bathroom was within regulatory requirements. All toxins, sharps and disinfectants were locked under kitchen sink and in locked garage. Kitchen and dining area were inspected. Food prep area is clean and organized. Food supply meets the requirement of one (1) week supply of non-perishable and two (2) day supply of perishables. Facility has a working centralized heater and air conditioner to use for cold or hot weather as needed. The home is maintained at a comfortable temperature for the clients. Temperature during the visit was 76.2 degrees F. Medication reviewed was labeled and stored and secured in a locked file cabinet in the office. Medication appears to have been dispensed accurately.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HEARTFELT CARE VILLA
FACILITY NUMBER: 306004778
VISIT DATE: 07/18/2023
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Staff First Aid and CPR certifications, staff training and medical assessments for staff were reviewed and found to be within Title 22 California Code of Regulations (CCR). LPA reviewed 3 client files, all were found to be within Title 22 CCR and had current Individual Program Plans (IPP). The clients P&I records were reviewed, LPA observed that an individual log is maintained for each client. All monies are accounted for and logs were kept to date.

LPA observed Fire Extinguisher was last serviced on 07/07/2023. Fire drill log reviewed, drills are conducted quarterly and last Fire Drill was conducted on 05/10/2023. Smoke and carbon monoxide detectors were tested and found to be operational. First Aid Kit had all required elements. Activity Supplies were available such as coloring, magazine, Zumba. Emergency supplies were observed in the office and ready to go in an event of an emergency.

Based on observations made, no deficiencies were observed at this time in the areas evaluated. Copy of this report will be sent to email on file.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC809 (FAS) - (06/04)
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