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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004826
Report Date: 12/26/2024
Date Signed: 12/26/2024 05:15:34 PM

Document Has Been Signed on 12/26/2024 05:15 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:ORANGEWOOD GUEST HOMEFACILITY NUMBER:
306004826
ADMINISTRATOR/
DIRECTOR:		MEL CARBAJAL MIN FAJARDOFACILITY TYPE:
740
ADDRESS:1598 W. ORANGEWOOD AVE.TELEPHONE:
(714) 583-8965
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
12/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Ruben CerbajelTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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On 12/26/2024 Licensing Program Analyst (LPA) William Vanegas made and unannounced visit for the purposes of conducting an annual visit. Upon arrival LPA Vanegas was greeted and granted entrance by caregiver (CG) Ruben Carbajel. LPA Vanegas set up equipment and conducting a tour of the facility and observed the following.

This is a one storied home that has four bedrooms, three of which are resident rooms and one staff room. This home has two bathrooms, one of which is a staff bathroom and another that is a resident bathroom. LPA observed kitchen area to be clean and free of debris. LPA observed a microwave, gas stove, and dish washer in kitchen all were tested and tested operational. LPA observed a washer and dryer to be operational. All toxins and detergents are locked away and out of resident reach.

LPA Observed smoke detectors and carbon monoxide detectors to be operational. Fire Extinguishers were observed to be up to date and fully charged. LPA observed resident and staff bathrooms to be clean and free of mildew and debris. Water temperature tested from 114.6-116.8 Degrees F. Resident restrooms were observed to have grab bars and slip resistant matts. Water faucet and toilets were observed to be operational.

LPA Vanegas observed the backyard of the facility to have a seated shading area with enough space to participate in outdoor activities. Emergency pathways were free of any obstructions, and side doors were observed to be unlocked. LPA Vanegas observed there to be a two day supply of perishable food and a seven day supply of non-persihable food and a sufficient amount of emergency water on hand for residents.

LPA Vanegas advised that due to time constraints LPA would need to return to complete the annual visit. No deficiency's were cited on today's date. An exit interview was conducted and a copy of this report was left at the facility
Armando J LuceroTELEPHONE: (714) 703-2866
William VanegasTELEPHONE: (714) 497-7621
DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/26/2024
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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