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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005518
Report Date: 03/24/2022
Date Signed: 03/24/2022 11:15:03 AM

Document Has Been Signed on 03/24/2022 11:15 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:JANEEN HOMEFACILITY NUMBER:
306005518
ADMINISTRATOR:JESSICA GARCIAFACILITY TYPE:
734
ADDRESS:1438 W JANEEN WAYTELEPHONE:
(657) 254-0274
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 5CENSUS: 3DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Administrator Leilani LibangTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced required annual inspection in this facility. LPA Marin met with Administrator (AD) Administrator Leilani Libang; and stated the purpose of this visit.

This facility is a single level structure and licensed as an Adult Residential Facility for Persons with Special Health Needs (ARFPSHN) and with fire clearance of five non-ambulatory of which five may be bedridden.

About 10:11 AM, LPA Marin toured the interior and exterior portions of the facility with AD Libang LPA observed three clients in care, five staff members and two day program representatives on the floor. There were five private client's rooms. Rooms were provided with specialized bed and appropriate linens; adequate storage space and furniture in good repair. Built in lift tracking devices were tested and observed to be operational. Medication drawer in each room were rendered inaccessible to clients in care. Bathrooms were observed to be in good repair, and provided with grab bars, and working built in lift device. Hot water was measured at 105 degrees Fahrenheit. Centralized smoke and carbon monoxide detectors were tested to be operational. Facility sprinkler system was stated to be inspected last August 25 2021 along with mounted fire extinguishers in place. Auditory exit alarms were observed to be operational. LPA observed clients doing activities. LPA observed several activity materials available for the client's use. Kitchen appeared clutter free. Facility met the minimum 2-day perishable and 7-day non-perishable food stock requirements. Sharp kitchen items and cleaning supplies were rendered inaccessible to clients in care. The facility has a working emergency power back up source. Spare oxygen tanks were kept and secured in an appropriate holding rack. Facility has adequate supplies of personal protective equipment (PPE). Exterior portions have shaded areas and provided with good furniture in good repair. Side exit door was self latching, and provided with auditory alarm.

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SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: JANEEN HOME
FACILITY NUMBER: 306005518
VISIT DATE: 03/24/2022
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(Continuation from Page 1)

LPA Marin reviewed the Coronavirus 2019 (COVID 19) mitigation plan of the facility. LPA discussed Assembly Bill 665 requires that a licensee of any adult or senior care residential facility that has internet service provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For this visit, no deficiencies noted for areas observed. No citation was issued.

LPA conducted an exit interview with AD L. Libang and copy of this report was left in the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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