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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004806
Report Date: 12/05/2024
Date Signed: 12/05/2024 04:32:16 PM

Document Has Been Signed on 12/05/2024 04:32 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/
DIRECTOR:
RAQUEL VALDIVIA GONZALEZFACILITY TYPE:
735
ADDRESS:1031 W. RICHLAND AVENUETELEPHONE:
(714) 547-1053
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY: 18CENSUS: 17DATE:
12/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH: Raquel Gonzalez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:46 PM
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Licensing Program Analysts (LPAs) Alvaro Ramirez Jr and Nancy Guillen are conducting this unannounced visit for the purpose of completing an annual required inspection. LPAs arrived at the facility and were greeted and granted entry by Administrator Raquel Gonzalez. LPAs explained the nature of the visit.

The facility is made up of 3 units which has 3 kitchens, 12 bedrooms- 2 of which are for staff use, 6 bathrooms- 2 of which are for staff use, a garage, and an office space. Seventeen clients reside at this facility. At the time of visit multiple clients were observed to be lounging in the common areas or napping in their respective rooms. LPAs began the tour of the inside and outside of the facility. LPAs observed required department postings posted on the wall of facility. There is a minimum of one week of non-perishables foods and two days of perishables foods available in the main kitchen. There is additional food storage in the spare two refrigerators in the garage. The facility is maintained at a comfortable temperature. LPAs observed that medication is centrally stored in a locked storage cabinet located in the facility office. LPAs reviewed medication and observed medications were labeled and stored inaccessible to clients in care. LPAs inspected the bathrooms and measured the hot water between 107 and 109 degrees Fahrenheit. All bathrooms observed to have a supply of soap, toilet paper and paper towels. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPAs observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in the garage and below the kitchen sink. The facility has an available clean supply of linens. LPAs inspected client’s bedrooms which have sufficient lighting to ensure the safety and comfort of clients. All bedrooms observed to have all required components. Carbon monoxide and smoke alarms were tested operational. Fire extinguishers were observed in the living space of each unit and were serviced on June 25,2024. LPAs toured the outside of the facility and observed outdoor passageways were free of obstructions. LPAs observed there is shaded seating areas for client’s enjoyment. LPAs began review of records.

Continued on LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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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: 12/05/2024
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LPAs reviewed five clients’ records. All the required documentation was present and current in client’s files reviewed. The facility P&I records were reviewed. LPAs observed that only one individual log is maintained for one client as all other clients manage their own money. Monies are accounted for and attached receipts for record keeping. LPAs reviewed three employee records. All employees present have a criminal record clearance and are associated to the facility. LPAs observed records reviewed have a current First Aid certificate.

Based on the observations 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: Nancy Guillen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
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