306005509-1-15-2026-22-AS-RMRT-DQCVVY-20260115154708

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005509
Report Date: 01/15/2026
Date Signed: 01/15/2026 03:47:16 PM

Document Has Been Signed on 01/15/2026 03:47 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:	LARCHWOOD HOUSE		FACILITY NUMBER:	306005509
ADMINISTRATOR/ DIRECTOR:	COOPER, JULIE		FACILITY TYPE:	734
ADDRESS:	857 LARCHWOOD DR		TELEPHONE:	(951) 279-2585
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY: 5		CENSUS: 5	DATE:	01/15/2026
TYPE OF VISIT:	Required - 1 Year	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Julie Cooper, Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	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. During the visit LPA met with Julie Cooper, Administrator (AD). The facility is a five bedroom, three bathroom single story residential home with an approved fire clearance for five non ambulatory clients; of which five may be bedridden. The facility currently has a census of five clients in care. During today's visit, LPA tested the smoke and carbon monoxide detectors and both were operational. The last fire sprinkler inspection was on February 12, 2025. The fire extinguishers were charged and inspected on December 15, 2025 and the last fire drill was conducted on December 12, 2025. The Automated External Defibrillator (AED) was inspected on January 7, 2026. LPA toured the kitchen and sharps and knives were secured in locked drawers and chemicals were secured under the sink. All appliances were in working order. LPA observed the refrigerator had two days perishable food supplies and seven days of non-perishable food on hand. The facility was clean with no odors. The garage contained emergency supplies and water and there is a generator on-site. LPA walked the exterior of the home where a five foot locked gate with an audio alarm secured the swimming pool. All pathways were clear of hazards and obstructions and a covered seating area is available for clients. LPA observed medication storage and reviewed the centrally stored medications. Per review, medications are being given as prescribed. A First Aid Kit had the required elements and a First Aid Book was available. (Continued on LIC 809-C)

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: 01/15/2026

NARRATIVE

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(Continued from LIC 809)

LPA visited client bedrooms and tested the hot water temperatures in two of two client bathrooms. The hot water temperature ranged between 105.1 to 106.2 degrees Fahrenheit. All client bedrooms have mechanical hoyer lifts from the ceiling; as well as the main bathroom shower.

LPA reviewed two of two staff training and fingerprint records. All staff are current in Cardiopulmonary Resuscitation (CPR) and AED training. There is always a medically licensed nurse on site. LPA reviewed a complete review of client records. Client records were reviewed and accurate. All clients are non-verbal but LPA was able to greet and engage with clients. All clients were clean, dressed and cared for. At the time of the visit, one client was doing a puzzle with staff and four clients were resting. This location has Day Program personnel and three of the clients had gone to the park in the morning and were tired. LPA interviewed staff present regarding care provided. The administrator has a current administrator certificate which expires on July 9, 2026.

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 and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit and will be mailed to the licensee.

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC809 (FAS) - (06/04)

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