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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005189
Report Date: 03/04/2025
Date Signed: 03/04/2025 11:16:26 AM

Document Has Been Signed on 03/04/2025 11:16 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:EJ HOMESFACILITY NUMBER:
306005189
ADMINISTRATOR/
DIRECTOR:		CRUZ, PLACIDA DELAFACILITY TYPE:
735
ADDRESS:1231 WEST ARLINGTON AVETELEPHONE:
(714) 244-0656
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: DATE:
03/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Emmanual VillacortaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit and was greeted and granted by Admin (AD) Jane Villacorta.
For today’s visit, LPA did not observe any clients at time of visit; all were at day program.
The facility is a one-story home with five bedrooms, three bathrooms, kitchen, dining room, living room, backyard and attached 1-car garage.LPA and AD tested smoke detectors/carbon monoxide in common areas and bedrooms; all tested and were operational. Clients bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each clients comfortably.

LPA observed fire extinguisher mounted in kitchen and garage areas with last inspection date of on Feb.25, 2025. Upon review of record, emergency drill log indicated that the last drill was conducted in June of 2023. A technical violation was given.


LPA observed sharps sand knives locked in the kitchen and were inaccessible to residents in care.
Restrooms toilets and water faucets were also observed to be operational. Grab bars were secure, and showers were observed to be free of mold/mildew. Water temperature measured between at 114.6 degrees Fahrenheit and 113.9 degrees Fahrenheit. LPA and AD toured the backyard of the facility and observed a shaded seating area for clients’ enjoyment. LPA checked emergency exits to be free of obstacles.

LPA observed required department postings displayed on the wall of facility. LPA observed the minimum of one week of non-perishables foods and two days of perishables foods available. LPA reviewed residents’ and staff files and observed they all had the required documentation.

Based on the observations made during today’s inspection, NO deficiencies is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to AD at end of inspection.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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