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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005404
Report Date: 03/27/2023
Date Signed: 03/27/2023 01:55:17 PM

Document Has Been Signed on 03/27/2023 01:55 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CAREASSURE RESIDENTIAL FACILITYFACILITY NUMBER:
306005404
ADMINISTRATOR:NAVAL JR, RUFINOFACILITY TYPE:
735
ADDRESS:28945 SANTIAGO PEAK LANETELEPHONE:
(949) 973-5016
CITY:TRABUCO CANYONSTATE: CAZIP CODE:
92679
CAPACITY: 4CENSUS: 4DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Rufino NavalTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility to conduct an annual required inspection. LPA arrived at facility was greeted and granted entry to the facility by Administrator. LPA met with Rufino Naval, Administrator and explained the nature of the visit.

There are four clients in care and LPA observed two clients having lunch in dinning room and was advised that two clients were out in the community. LPA along with Administrator began the tour of the physical plant of the facility. LPA inspected the kitchen and food storage areas. Food supply was observed to be two day supply of perishables and seven day supply of non-perishables foods on hand. Fresh fruit and vegetables are readily available for clients. LPA observed a locked space for sharps and cleaning supplies locked underneath kitchen sink. LPA toured all the client’s bedrooms. The facility has four private bedrooms designated for clients and one employee bedroom. LPA observed all client’s bedroom that all the required furnishings were present. LPA observed that smoke detectors to be operational. There is a locked cabinet storage for client’s medication, LPA reviewed medication and it was observed all medication was labeled. LPA toured the bathroom designated for clients bathing. The hot water temperature measured 111.8 Fahrenheit degrees. LPA checked the outside perimeters of the home. All passageways are clear and free obstruction. LPA observed a shade seating area for clients use. LPA reviewed facility records; LPA reviewed four client records. 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. LPA reviewed two employee records. All employees present have a criminal record clearance. During the inspection LPA spoke to available clients and staff.

Based on the observation 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 Administrator and a copy of this report provided and left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
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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