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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005418
Report Date: 01/10/2025
Date Signed: 01/10/2025 09:16:18 AM

Document Has Been Signed on 01/10/2025 09:16 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:JC HOME FOR SENIORS - LOVEFACILITY NUMBER:
306005418
ADMINISTRATOR/
DIRECTOR:		PARUNGAO, MARIA- EMETERIOFACILITY TYPE:
740
ADDRESS:19851 ISTHMUS LANETELEPHONE:
(714) 968-9795
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 5TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/10/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:27 AM
MET WITH:Caregivers, Lydia Sanguyo and Pelaga EstevesTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA), Jenifer Tirre, conducted a visit today to conduct a plan of correction visit in reference to the citations issued last annual required visit dated December 16, 2024. LPA Tirre was granted entry by Caregiver. Caregiver called Licensee Jay Parungao. LPA talked with Licensee Parungao regarding purpose of visit. Licensee and Administrator Jay Parungao was unavailable to come down to facility due to a previously scheduled appointment. Licensee Parungao stated that they give permission to caregivers to sign report on their behalf.

On December 26, 2024, Licensee Parungao provided photos of corrections and proof of in service training to Department via email.

During today's visit, the following citations were reviewed for plan of correction:
1) 87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
Per Annual Required visit on 12/16/2024, LPA Tirre observed two out of four stove burners were non- operational on stove top. LPA Tirre observed during today's visit that four of four burners were operational. Licensee fixed burners and Deficiency is cleared.

2) 87555 General Food Service Requirements
(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.

CONTINUED ON 809C
Lourdes MontoyaTELEPHONE: (714) 703-2870
Jenifer TirreTELEPHONE: (714) 401-6844
DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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: JC HOME FOR SENIORS - LOVE
FACILITY NUMBER: 306005418
VISIT DATE: 01/10/2025
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Per Annual Required visit on 12/16/2024, LPA Tirre observed Facility had several food items such as oatmeal, turkey bacon and ground beef that were past expiration date. LPA Tirre inspected several food items inside two Refrigerator's and Pantry shelves. LPA observed expiration dates were current. Licensee to check monthly food supplies and provide a in service training regarding food service requirements.

On December 26, 2024, Licensee provided copy of In service training via email. Deficiency is cleared.

Facility will continuously comply to avoid future citations or civil penalty.
An exit interview was conducted and copy of report was reviewed with Caregivers Lydia Sanguyo. A copy of report was provided to facility.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
LIC809 (FAS) - (06/04)
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