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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005173
Report Date: 01/19/2024
Date Signed: 01/19/2024 01:26:52 PM

Document Has Been Signed on 01/19/2024 01:26 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 ASC, 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:
01/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Angelia Kruger - AdministratorTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. made an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by Administrator (AD) Angelia Kruger.

The facility is a one-story home with four resident bedrooms, two bathrooms, kitchen, dining room, living room, staff room, craft room and backyard. AD stated all clients were away at day program at the time of the inspection. AD stated facility is currently reorganizing files and supplies. Facility appears sanitary. All residents rooms had required elements, including bed, chair, closet space and ample lighting. Facility has extra linens for residents in closets. Restrooms are stocked with soap and paper towels. Hot water in both bathrooms measured at 112.7 degrees Fahrenheit and 118.3 degrees Fahrenheit. LPA observed facility has emergency food and water supply. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up. Knives and sharps are locked in a cabinet in the kitchen, chemicals are locked separately in storage. Medication for each resident is kept locked. Exit gates are unlocked and the paths leading to them were observed to be unobstructed. LPA reviewed two of the four client files, two of the four client medication, the personnel file and the P&I. Medication, files and client money appeared to be properly stored and documented. Facility has board games, exercise equipment, toys, electronics and more for client use. Emergency contacts, Menu and Calendar are posted and available for review.

No deficiencies were noted during today's visit. An exit interview was conducted and a copy of this report was provided to the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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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