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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004826
Report Date: 10/11/2023
Date Signed: 10/11/2023 10:13:28 AM


Document Has Been Signed on 10/11/2023 10:13 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:ORANGEWOOD GUEST HOMEFACILITY NUMBER:
306004826
ADMINISTRATOR:MEL CARBAJAL MIN FAJARDOFACILITY TYPE:
740
ADDRESS:1598 W. ORANGEWOOD AVE.TELEPHONE:
(714) 583-8965
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 4DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Melissa Carbajal - AdministratorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at Orangewood Guest Home to conduct an unannounced Required 1 Year Inspection. LPA arrived at the facility at 8:30am, LPA was greeted and granted entry by Administrator (AD) Melissa Carbajal.

The facility is a one-story home with three resident bedrooms, two bathrooms, living room, kitchen, dining room, backyard, one staff bedroom, one office and an attached one car garage. There are two exit gates on either side of the house. There is one shaded seating area in the backyard. LPA did not observe any hazards or obstacles in back yard. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients and will be stored and locked in cabinets in the kitchen and laundry room. Medication and Files are stored in a locked cabinet in the dining room. First aid kit is locked in a hallway cabinet. LPA reviewed two out of four client files and medication. LPA reviewed three staff files. The clients were away at day program or appointments. The two fire extinguishers are fully charged as indicated by the arrow pointing in the green zone. LPA observed service tags to indicate the extinguisher was last serviced on 10/10/23. The facility has books, puzzles, exercise equipment and electronics for activity use. The facility also conducts group outings each weekend. All bathrooms have working plumbing and designated hand washing posters. Hot water measured at 108.5 degrees Fahrenheit in the hallway bathroom, 107 degrees Fahrenheit in the bathroom inside bedroom 3. A supply of extra linen and hygiene supplies was stored in the hallway cabinets and garage. Emergency Phone Numbers, Exit Plan & Menu are posted and available for review. There is a 2-day supply of perishable food and 7-day supply of non-perishable food on hand. Smoke detectors and carbon monoxide detector tested operational. Stove with gas burners, oven, refrigerators, dish washer, microwave, washer and dryer are operational.
Based on the observations made during today's visit, no deficiencies are being cited as per Title 22 Division 6 Chapter 2 of the California Code of Regulations. An exit interview was conducted with Administrator Melissa Carbajal, and a copy of this report was provided.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
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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