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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005173
Report Date: 01/17/2025
Date Signed: 01/17/2025 10:44:52 AM

Document Has Been Signed on 01/17/2025 10:44 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:KRUGER HOME LLCFACILITY NUMBER:
306005173
ADMINISTRATOR/
DIRECTOR:		KRUGER, ANGELIAFACILITY TYPE:
735
ADDRESS:425 S WALNUT AVETELEPHONE:
(714) 713-6544
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: 5CENSUS: 4DATE:
01/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Angelia Kruger, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Angelia Kruger. During today’s visit, LPA met with Angelia Kruger, Administrator (AD).

The facility is a level 2, six-bedroom, three bathroom single story home with an approved fire clearance of five ambulatory. The facility currently has a census of five clients in care. At the time of LPA's visit, all clients were at Adult Day Program.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in one of one client bathrooms. Two of the three bathrooms are private with one in another hallway and one in the master bedroom where the Administrator lives. The hot water temperature measured 113.9 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational. The fire extinguisher is charged and was serviced on June 1, 2024. The facility’s last fire drill was conducted on November 8, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed.

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of client records. Client P&I records were reviewed and were accurate. LPA was not able to interview clients since all were at Adult Day Program but LPA spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on August 28, 2025.

(Continued LIC 809-C)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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: KRUGER HOME LLC
FACILITY NUMBER: 306005173
VISIT DATE: 01/17/2025
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(Continued from LIC 809)

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Angelia Kruger, Administrator (AD) and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
LIC809 (FAS) - (06/04)
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