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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005332
Report Date: 05/16/2023
Date Signed: 05/16/2023 08:49:05 PM

Document Has Been Signed on 05/16/2023 08:49 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:MEGAN CARE HOMES/BIXBYFACILITY NUMBER:
306005332
ADMINISTRATOR:MASINSIN, AUGUSTOFACILITY TYPE:
735
ADDRESS:613 EADINGTON AVETELEPHONE:
(714) 588-3112
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 4CENSUS: 4DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Augusto MasinsinTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility to conduct an Annual Required evaluation. LPA was greeted and granted entry by Administrator, Augusto Masinsin. LPA confirmed that Administrator has a current administrator certificate, which expires on 10/14/2023.

The facility currently has 4 clients; 3 present during today's visit. LPA Martinez, along AD Masinsin conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following: Facility is a one story house with 4 bedrooms, 2 bathrooms, living room, kitchen, dining room, laundry room and an attached two car garage that is used for storage. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. The back yard has a patio cover with a table and chairs for clients and visitors use.

Client bedrooms were observed to be spacious and easily accommodate furnishings such as lamps, chair, dresser and a bed. Bathrooms were clean, faucets, showers and toilets were operational. Hot water temperature in client bathroom was within regulatory requirements. Linen and hygiene supplies were stocked in hallway closet. Emergency Phone Numbers and Exit Plan were reviewed. Food prep area is clean and organized. Hygiene supplies are provided for number of client's in care. Food supply was noted to be in sufficient quantities to meet the regulatory requirements of a 2-day perishables and 7-day non-perishables. Emergency food and water supply is available. Smoke detectors and carbon monoxide detectors were found to be operational. Fire Extinguisher were charged and mounted. Fire drills are conducted once a month and LPA verified last Fire Drill was conducted on 04/15/2023. Stove burners, microwave, dishwasher, washer, and dryer are operational. Chemicals and sharps are made inaccessible to the clients. Medications are centrally stored in a locked kitchen cabinet. Medications reviewed appear to have been dispensed accurately.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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: MEGAN CARE HOMES/BIXBY
FACILITY NUMBER: 306005332
VISIT DATE: 05/16/2023
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First-Aid Kit had all the required elements and Activity Supplies were observed and available. There is a working land line at the facility. The LIC610D, Emergency Disaster Plan is posted.

LPA reviewed four client files and one staff file. The clients P&I records were reviewed, LPA observed that an individual log is maintained for each client. All monies are accounted for and logs were kept to date.

In order to update CCL file, please provide the following updated documents to CCL by 05/25/2023: 1.) Designation of Administrative Responsibility (LIC308) 2.) Personnel Report (LIC500); 3.) Emergency Disaster Plan (LIC610D); 4.) Surety Bond; and 5.) Administrator certificate.



Based on observations made, no deficiencies were observed at this time in the areas evaluated. Copy of this report will be sent to email on file.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC809 (FAS) - (06/04)
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