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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004806
Report Date: 12/26/2023
Date Signed: 12/26/2023 04:00:45 PM

Document Has Been Signed on 12/26/2023 04:00 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: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:
12/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Raquel Valdivia GonzalezTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility was greeted and granted entry by Raquel Valdivia, Administrator and LPA explained the nature of the visit. Their is currently 17 clients residing at the facility.

Upon entry LPA observed clients throughout the facility. The facility consists of two separate single story buildings; one building has two units for client bedrooms and the other single story unit has the office space, kitchen and client bedrooms. LPA accompanied by Administrator began the tour of the physical plant of the facility. LPA observed the required department postings in the office of the facility. The facility stays within the capacity limitations. LPA toured the facility kitchen and observed there was a minimum of one week of non-perishables foods and two days of perishables food available. There is additional food in the detached garage that is partially used as a pantry and storage. LPA observed the facility has two refrigerators and two freezers for food storage. The facility is maintained at a comfortable temperature. LPA inspected that the medication is centrally stores in a safe locked storage cabinet located in the office. LPA reviewed medication and observed that the medication was labeled and stores inaccessible to clients in care. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink and in the garage. LPA inspected client’s bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for clients in their bedroom. The facility has an available clean supply of linens stored in each unit. Smoke detectors were tested and found to be operational. LPA inspected the bathroom and LPA measured the hot water temperature which measured 112.2 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA toured

Continued on LIC809-C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/26/2023
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: RICHLAND GUEST HOME
FACILITY NUMBER: 306004806
VISIT DATE: 12/26/2023
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the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there is shaded seating areas for client’s enjoyment. LPA observed several fire extinguishers throughout the facility with service date of June 12, 2023. Fire drills conducted twice a year and LPA verified last Fire Drill was conducted on December 12, 2023. LPA began review of records. LPA reviewed seven clients’ records. All the required documentation was present and current in client’s files reviewed. The facility P&I records were reviewed. LPA observed that an individual log is maintained for each client, all monies are accounted for. LPA reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023
LIC809 (FAS) - (06/04)
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