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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004811
Report Date: 07/30/2024
Date Signed: 07/30/2024 09:50:50 AM


Document Has Been Signed on 07/30/2024 09:50 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:CHAPTERS RCFEFACILITY NUMBER:
306004811
ADMINISTRATOR:RAMIREZ-RADABAUGH, RENEEFACILITY TYPE:
740
ADDRESS:24221 CHRISANTA DRIVETELEPHONE:
(949) 647-9240
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 4DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:00 AM
MET WITH:Joshua Radabaugh- AdministratorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual inspection using the CARE Tool. LPA was greeted and granted entry by Administrator Joshua Radabaugh and explained the reason for the visit.

This is a single story facility with a loft. Facility is operating within the conditions and limitations specified on the license. During today's visit, LPA observed four residents in care with three on hospice and one live-in caregiver and Administrator Joshua on duty.

LPA observed the facility to be clean and sanitary. There are four resident bedrooms and two resident bathrooms. There is an additional private bedroom for the staff in the loft. All common areas were inspected including the attached two car garage which also doubles as a laundry room and office. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, clean supply of linens and adequate lighting was provided in addition to sufficient storage space for each residents' personal belongings. Bathrooms were found to be in compliance, clean, and operational. The water temperature measured at 109.0 and 109.4 degrees Fahrenheit. LPA observed the indoor temperature was within a comfortable range. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available. The stove top was lit unassisted. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway free of obstruction. The exit gate was in good repair. LPA observed sufficient seating and shading. Facility maintains fire extinguishers which were mounted, charged, and purchased on July 30, 2024. The auditory devices and smoke/carbon monoxide detectors were tested and operational. Emergency disaster supplies including food/water were present in the garage. Emergency evacuation drills were conducted on a quarterly basis. The first aid kit contains all necessary elements.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
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 4


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: CHAPTERS RCFE
FACILITY NUMBER: 306004811
VISIT DATE: 07/30/2024
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LPA observed the required 'See Something, Say Something' (PUB475) poster in an incorrect size of 8.5"x14." LPA verified that Administrator Joshua Radabaugh has completed all course work which was submitted to the Department on April 3, 2024.

LPA conducted an audit of four residents' files and one personnel files. Residents/staff interviews were not conducted due to residents sleeping at the time or getting ready for the day. Staff was also not interviewed due to assisting residents in the morning. Medications were audited. No discrepancies noted.

Based on the observations made during today's visit, no deficiencies are being cited. Advisory Notes are being issued.

An exit interview was conducted with Administrators Joshua Radabaugh and Renee Ramirez-Radabaugh who was present by telephone approximately 9:30am, and copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4