<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005209
Report Date: 03/05/2024
Date Signed: 03/05/2024 11:41:53 AM


Document Has Been Signed on 03/05/2024 11:41 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:GOLDEN TIARA GUEST HOMEFACILITY NUMBER:
306005209
ADMINISTRATOR:GONZALES, DESIDERIOFACILITY TYPE:
740
ADDRESS:1776 S TIARA STREETTELEPHONE:
(714) 317-4324
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 4DATE:
03/05/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Tim Ycasas, Licensee/AdministratorTIME COMPLETED:
11:45 AM
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
This unannounced Case Management – Health Checks inspection is being conducted by Licensing Program Analyst (LPA) Rosie Quiroz for the purpose of a health and safety check and to follow up on a self-reported inquiry in the Orange County Regional Office (OCRO) on 03/04/24 regarding a facility change of location with the intent to purchase a property instead of renting due to loss of control of property of this facility location effective 5/2/2024.
LPA was greeted by Caregiver 1 (CG1) Dionisio Cueto. LPA Quiroz called and spoke to Licensee/Administrator (L/AD) Desiderio Gonzales and discussed the purpose of the inspection visit. (L/AD) Tim Ycasas arrived during today's visit.
(L/AD) Ycasas indicated that two of four clients in care are with Regional Center of Orange County and have been informed of placement plans in placed and indicated 2 of 4 clients responsible parties have been notified as well.
During today’s inspection, LPA Quiroz along with (CG1) toured the interior and exterior of the facility premises and observed three (3) clients in care and 2 caregiver during today's inspection tour. (L/AD) Ycasas indicated Client 4 is currently at Day Program. LPA conducted health and safety checks on the clients present and observed no imminent health and safety concerns. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations, the electricity and water were running, the facility had soap and paper towels, and the medications, sharps, and toxins were properly stored.

There were no health and safety concerns observed in the areas inspected.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with (L/AD) Ycasas and a copy of this report and LIC 811- Confidential names were provided at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
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 1