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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005333
Report Date: 01/20/2023
Date Signed: 01/20/2023 07:05:01 PM


Document Has Been Signed on 01/20/2023 07:05 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:ORANGE HILL ELDERLY CAREFACILITY NUMBER:
306005333
ADMINISTRATOR:RODRIGUEZ, FRANCISFACILITY TYPE:
740
ADDRESS:2586 N ORANGE HILL RDTELEPHONE:
(714) 602-6072
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY:6CENSUS: 5DATE:
01/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
06:22 PM
MET WITH:Glenn NavarroTIME COMPLETED:
07:18 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced case management visit. LPA met with facility staff and explained the reason for the visit. The Agency received a report that the City of Orange Fire Department was called to the facility. At the facility at approximately 4:00 pm food in the oven began to smoke excessively. Staff used a fire extinguisher on the oven and called 911 and the Fire Department responded to the call. No damage was done to the facility. As a precautionary measure the Fire Department disconnected the stove. Administrator Jennifer Brower was not present at the time of the visit but spoke to the LPA on the phone, she reported that they are going to purchase a new stove tomorrow and would provide meals using the microwave and possibly ordering food to be brought in for residents. LPA observed the kitchen and the stove have been cleaned. There is no evidence that a fire extinguisher was used in the kitchen. LPA observed all residents were in their rooms and staff reported everyone is doing fine. Staff reported no one was hurt during the incident. LPA did not observe any health or safety concerns. The facility is clean and the room temperature in the living room and kitchen is 73.0 degrees Fahrenheit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
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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