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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005509
Report Date: 01/16/2025
Date Signed: 01/16/2025 11:40:13 AM

Document Has Been Signed on 01/16/2025 11:40 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:LARCHWOOD HOUSEFACILITY NUMBER:
306005509
ADMINISTRATOR/
DIRECTOR:		COOPER, JULIEFACILITY TYPE:
734
ADDRESS:857 LARCHWOOD DRTELEPHONE:
(951) 279-2585
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: 5CENSUS: 5DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:07 AM
MET WITH:Julie Cooper, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 8:07am. During today’s visit, LPA met with Julie Cooper, Administrator (AD).

The facility is a single story, five bedrroom, three bathroom residential home with an attached garage and basement and has an approved fire clearance for five non-ambulatory and five bedridden. The facility currently has a census of five clients in care.

During today’s visit, LPA toured the facility and inspected the physical plant; testing all smoke detectors, testing hot water temperature in three of three client bathrooms, and testing auditory devices on all exits. LPA observed ceiling Hoyer lifts in all client bedrooms with proper linens and required furnishings. The hot water temperature measured between 107.4 and 107.7 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on December 24, 2024. The facility’s last fire drill was conducted on December 12, 2024. LPA observed the Automated External Defibrillator (AED) which was checked on January 6, 2025.

LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid Kit had all of the required elements with an American Red Cross manual.

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of client records. Client P&I records were reviewed and were accurate. LPA engaged with clients regarding their quality of care and spoke to staff present regarding care provided.
(Continued on LIC 809-C)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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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: LARCHWOOD HOUSE
FACILITY NUMBER: 306005509
VISIT DATE: 01/16/2025
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(Continued from LIC 809)

LPA confirmed that the administrator has a current administrator certificate which expires on July 9, 2026.

LPA noted there were four staff members present for the five clients in care. LPA observed clients listening to music, watching TV and one client was doing a tactile activity. There is an outdoor pool that is secured by a locked fence and audible alarm and a lift for clients to use in the warmer months. There is a covered patio and all exit gates were in working order. Oxygen in use signs were noted and video surveillance is for the outside perimeter of the property.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Julie Cooper, Administrator (AD) and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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