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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005518
Report Date: 01/29/2024
Date Signed: 01/29/2024 10:42:30 AM

Document Has Been Signed on 01/29/2024 10:42 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 ASC, 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: 4DATE:
01/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Administrator - Jessica GarciaTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. conducted an unannounced inspection at Janeen Home (ARFPSHN) for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by Psychiatric Technician (PT) Erika Werstler. Administrator (AD) Jessica Garcia joined the inspection at approximately fifteen minutes after LPA's arrival.

The facility is a one-story home with five bedrooms, two bathrooms, kitchen, dining room, living room, lounge, backyard and attached two-car garage. LPA observed residents participating in day program activities at the facility. Residents have one-on-one staff members from Assisted Integration Services (AIS) to engage with them for their day program activities. Facility appears thoroughly clean, sanitary, organized, comfortable and accommodating for all residents. All residents rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured at 107.6 degrees Fahrenheit in the bathroom immediately across from the kitchen. Hot water measured at 106.4 degrees Fahrenheit in the bathroom down the hall from the lounge room. LPA observed facility has emergency food, water and oxygen supply stored in the garage. The fire extinguishers were fully charged as indicated by the arrow pointing in the green section on the meter. Extinguishers were last serviced on 1/2/2024. The facility has two sharps containers to dispose sharps into. Medication for each resident is kept in locked drawers in their respective rooms. The top two drawers in the dresser in each residents' room is dedicated to their medication. Only nurses have access to the medication. The backyard has two shaded seating areas and a garden for the residents. The residents are able to garden as one of their activities. Activities also include puzzles, arts and crafts, board games, music therapy and more. The exit gate is unlocked and self latching. LPA reviewed all four residents files, each contained required documentation. LPA reviewed P&I for all four residents. LPA reviewed four staff files.

Based on today's inspection, no deficiencies are being issued. An exit interview was conducted with Administrator Jessica Garcia. A copy of this report was provided

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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