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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004827
Report Date: 01/22/2025
Date Signed: 01/22/2025 03:01:26 PM

Document Has Been Signed on 01/22/2025 03:01 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:CHATEAU'S GUEST HOMEFACILITY NUMBER:
306004827
ADMINISTRATOR/
DIRECTOR:		MEL CARBAJAL MIN FAJARDOFACILITY TYPE:
735
ADDRESS:1914 W. CHATEAU AVE.TELEPHONE:
(657) 208-3225
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 4DATE:
01/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Melissa CarbajalTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On this day Licensing Program Analysts (LPAs) Samer Haddadin and Fred Arias made an unannounced visit to conduct a required annual visit. LPAs were greeted and granted entry into the facility by Administrator (AD) Melissa Carbajal and Mindy Fajardo and explained the reason for the visit. Facility is licensed for 6 ambulatory clients. Facility currently has 4 clients. ADs Melissa Carbajal and Mindy Fajardo have valid certificates that expire on 5/25/2026. AD Carbajal provided updated liability insurance that expires on 10/24/2025.

LPAs along with Administrator Fajardo toured the facility at 1:45PM. LPAs toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 3 client bedrooms, living room, dining room, and kitchen as well as 2 client bathrooms. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each client comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 118.3 degrees F and 119.3 degrees F in all bathrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPAs toured the kitchen and observed sharps locked in a drawer during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPAs reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 12/18/2024. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of outdoor trips. There is shaded outdoor seating for clients. Exit gate is unlocked and operational. LPAs observed the emergency food and water supply. LPAs reviewed two client files and two staff files. All client files contained required documentation including admission agreements, physician reports, and client appraisals.
CONTINUED ON LIC 809C DATED 1/22/2025
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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: CHATEAU'S GUEST HOME
FACILITY NUMBER: 306004827
VISIT DATE: 01/22/2025
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Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPAs reviewed medication storage and administration. Medications are stored in a locked closet. LPA reviewed client cash resources.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
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