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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005331
Report Date: 05/24/2022
Date Signed: 05/24/2022 11:11:40 AM

Document Has Been Signed on 05/24/2022 11:11 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:MEGAN CARE HOMES/OMA PLACEFACILITY NUMBER:
306005331
ADMINISTRATOR:JACINTO, ASUNCIONFACILITY TYPE:
735
ADDRESS:1501 S ROOSEVELT AVETELEPHONE:
(714) 588-3112
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 4CENSUS: 4DATE:
05/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Anil Suresh and Assistant Administrator Sonia JacintoTIME COMPLETED:
11:20 AM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and was granted entry into the facility by Caregiver. LPA Tirre met with Licensee Anil Suresh and Assistant Administrator Asuncion (Sonia) Jacinto and explained the reason for the visit.

During the visit LPA toured the facility with Licensee. Facility is a 4 bedroom and 2 bathroom single story home. There are 4 Clients in care. LPA observed proper covid signage at front entrance of facility as well as sanitization and temperature check station. Facility has required Department postings, posted throughout facility. LPA toured all clients rooms, all rooms where within regulations. All restrooms observed contained working wash basin, soap toilet paper and towels are provided upon using restrooms. Restrooms had proper hand washing signs posted. LPA observed Clients relaxing in living room watching TV.

Facility has 30 days worth of PPE supplies. LPA observed emergency food and water supply. Facility has 2 fridges with ample food supply. Facility has required Emergency Disaster Plan posted. Facility has a secured location for Client medication and files. Facility has 30 days supply of medications for clients. LPA reviewed Clients files during visit. 4 of 4 clients files were observed. Clients emergency contact information and Physicians reports are current. Facility has centrally wired operational smoke detectors and 1 fire extinguisher fully charged and mounted. Facility has designated area for visitors.

An exit interview was conducted with Licensee and copy of report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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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