306005186-10-7-2022-22-AS-JHAY-CJYQXB-20221007123315

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005186
Report Date: 10/07/2022
Date Signed: 10/07/2022 12:33:21 PM

Document Has Been Signed on 10/07/2022 12:33 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:	J AND P HOMES ORCHID		FACILITY NUMBER:	306005186
ADMINISTRATOR:	SANTOS, MELBA M		FACILITY TYPE:	735
ADDRESS:	7971 ORCHID DRIVE		TELEPHONE:	(714) 296-5135
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY: 6		CENSUS: 5	DATE:	10/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Margie Santos		TIME COMPLETED:	12:40 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year infection control annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. Staff called the Administrator (AD) Melba Santos to notify her LPA was present for the annual inspection. AD Santos has a current Administrator certificate that expires 6/30/24.

At 10:50 AM LPA Haley began the tour of the facility with staff. There were five clients present for the visit. Six client bedrooms were observed and five of six client bedrooms were clean, well organized, and had all necessary requirements: night stand, chair, lamp and storage space. In client bedroom #1 workers were working to replace the floor during the visit. LPA was advised the floor will be completed by the end of the day and all client items will be placed back in the room. LPA will be notified once the floor is completed and all items are put back in place.

In a locked hallway closet LPA Haley observed a supply of N95 mask, surgical mask, emergency kits for all clients, two disaster kits, an extra supply of non-perishable food items, and a emergency supply of water.

The client bathroom was clean and organized. Hot water temperature was measured at 116.7 degrees Fahrenheit in client bathroom #1. In client bedroom #3, the hot water temperature measured at 109.2

The kitchen was clean and organized. All knives and sharp objects were locked under the sink, and all hazardous cleaning chemicals were locked under the sink in a separate cabinet from the sharp objects. All burners on the stove were operational. The facility has a two day supply of perishable food items and seven day supply of non-perishable food items. Client medication is kept in a locked cabinet next to the refrigerator, and a first aid kit with all required elements was observed in the locked medication cabinet.

Continued on LIC809C Dated 10/7/22

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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: J AND P HOMES ORCHID	FACILITY NUMBER: 306005186
	VISIT DATE: 10/07/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The garage was clean, organized and walkways were free of clutter and tripping hazards. LPA observed a locked cabinets with hazardous chemicals, additional PPE supplies, and plenty of adult diapers.

The backyard was clean, organized, and free of clutter. A table with a sun shade and chairs was observed. Both side exit gates were self closing and self latching. LPA observed some loose tools in the back yard and LPA advised the staff of the importance of keeping all tools looked and inaccessible to clients.

In the living room LPA Haley observed a locked cabinet used to store client files. Next to the locked cabinet there was a fire extinguisher mounted and fully charged. LPA Haley observed an additional screening station in the living room with a temperature thermometer for screening clients and visitors, as well as mask, gloves and hand sanitizer.

There were no bodies of water observed. Smoke detectors tested and are operational. No deficiencies are being cited during todays visit. An exit interview conducted and a copy of the report was provided.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2