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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005383
Report Date: 01/16/2024
Date Signed: 01/16/2024 03:40:40 PM

Document Has Been Signed on 01/16/2024 03:40 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VA & C HOMES/BRIDGEPORTFACILITY NUMBER:
306005383
ADMINISTRATOR:ANTHONY AUFACILITY TYPE:
735
ADDRESS:2859 W. BRIDGEPORT AVE.TELEPHONE:
(714) 952-9641
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 6DATE:
01/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Isagani De Los Trinos
Maxine Kniazeff		TIME COMPLETED:
04:05 PM
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Licensing Program Analysts (LPAs) Ruth Martinez and Jenifer Tirre are conducting this unannounced visit for the purpose of completing an annual required inspection. LPAs arrived at the facility were greeted and granted entry by the caregiver and LPA Martinez explained the nature of the visit. LPAs met with Maxine Kniazeff, Assistant Administrator shortly after.

Six clients reside at this facility, there was three clients present at the facility at the time of visit. LPAs were informed that three clients were out in the community. Upon entry LPAs observed three clients and five staff throughout the facility. LPAs accompanied by caregivers began the tour of the inside and outside of the facility. LPA observed required department postings posted on the wall of facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. The facility is maintained at a comfortable temperature. LPA Tirre inspected that medication are centrally stored in a safe locked storage cabinet located the office space. LPA reviewed medication and observed medication was labeled and stored inaccessible to clients in care. LPAs inspected the bathroom and LPA measured the hot water temperature which measured 119.8 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in the garage. The facility has an available clean supply of linens. LPA inspected client’s bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for clients in their bedroom. Smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there is shaded seating areas for client’s enjoyment. LPA observed a fire extinguisher with service date of July 26, 2023, in kitchen. Fire drills are conducted monthly, and LPA Martinez verified last Fire Drill was conducted on January 05, 2024. LPAs

Continued on LIC809-C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: VA & C HOMES/BRIDGEPORT
FACILITY NUMBER: 306005383
VISIT DATE: 01/16/2024
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began review of records. LPA reviewed six clients’ records. All the required documentation was present and current in the client’s files reviewed. The facility P&I records were reviewed. LPA observed that an individual log is maintained for each client. All monies are accounted for and attached receipts for record keeping. LPA reviewed two employee records. All the employees present have a criminal record clearance and are associated to the facility.

Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the facility representative, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC809 (FAS) - (06/04)
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