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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005173
Report Date: 02/15/2022
Date Signed: 02/15/2022 02:39:32 PM

Document Has Been Signed on 02/15/2022 02:39 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:KRUGER HOME LLCFACILITY NUMBER:
306005173
ADMINISTRATOR:KRUGER, ANGELIAFACILITY TYPE:
735
ADDRESS:425 S WALNUT AVETELEPHONE:
(714) 713-6544
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: 5CENSUS: 4DATE:
02/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Angelia Kruger - AdministratorTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Kruger Home LLC. The purpose of today's visit was to conduct a Required 1 Year inspection. LPA Velazquez was allowed entry into the facility and met with Administrator (AD) Angelia Kruger. The facility is licensed for 5 ambulatory clients. There are currently 4 clients living in the facility. The last emergency disaster drill was conducted on November 10, 2021.


At 1:20 PM LPA Velazquez conducted a tour of the physical plant along with AD Kruger. The 1 story home consists of 4 client bedrooms and 2 staff bedrooms with 3 bathrooms. The 4 clients in the facility appeared well-groomed and well cared-for. Per AD Kruger no client or staff has tested positive for COVID-19 during the Pandemic. The client bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each client comfortably. Client bath towels and personal hygiene supplies were adequately stocked. Client bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew and a non-skid surface or mat was in place. LPA Velazquez tested the hot water temperature in the client bathrooms and the temperature ranged from 120.3 to 125 degrees Fahrenheit. LPA immediately notified AD so that the temperature could be lowered. AD proceeded to adjust the temperature of the tankless water heater. LPA Velazquez inspected the kitchen along with AD Kruger. Perishable and non-perishable food supply was checked and adequately stocked at the time of the visit. The fire extinguisher was fully charged. The smoke and carbon monoxide detectors were tested and found to be operational. Toxins, sharps, and medications were locked and inaccessible to clients. First Aid kit and manual were checked and found to be in order.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: KRUGER HOME LLC
FACILITY NUMBER: 306005173
VISIT DATE: 02/15/2022
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LPA Velazquez along with AD Kruger toured the outside grounds and no bodies of water were observed. There was shading and sufficient seating for clients. Walkways around the home were clear of hazards and the exit gates were operational. There were no security bars or weapons on the premises.

No client or staff files were reviewed at the time of this visit.


There were no deficiencies issued during this Required 1 Year inspection. An exit interview was conducted with Administrator Angelia Kruger and a copy of this report along with the LIC 9102 was provided at the time of this visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC809 (FAS) - (06/04)
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