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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004806
Report Date: 11/01/2022
Date Signed: 11/01/2022 03:40:51 PM

Document Has Been Signed on 11/01/2022 03:40 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:RICHLAND GUEST HOMEFACILITY NUMBER:
306004806
ADMINISTRATOR:RAQUEL VALDIVIA GONZALEZFACILITY TYPE:
735
ADDRESS:1031 W. RICHLAND AVENUETELEPHONE:
(714) 547-1053
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY: 18CENSUS: 17DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Raquel GonzalezTIME COMPLETED:
04:00 PM
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On 11/01/2022 , Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Administrator Raquel Gonzalez

LPA accompanied by administrator toured the physical plant. There are currently seventeen (17) clients in care. The facility consists of four single story bungalows separated by gender with one building which is co-ed and a bungalow for office and storage space which is locked when not attended. The bedrooms includes all necessary components of furnishing. An ample supply of linen is observed. The bathrooms are equipped with slip mats. Staff present is adequately cleared and associated in Guardian. The Administrator certificate is shown to be current and valid. The fire extinguishers present are mounted and charged. The maintenance tags attached are current. Resident areas were noted to be a comfortable temperature.

Sharp instruments are stored away in a locked drawer. The centrally stored medication are located in several locked drawers assigned to the three medication dispensing rounds of the day. Cleaning supplies are securely locked in the garage. LPA observed a sufficient supply of food and water present in the kitchen and pantry.

LPA and administrator toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and a shaded area is present for the enjoyment of clients and visitors. There are no bodies of water on the premises.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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