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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005543
Report Date: 06/19/2024
Date Signed: 06/19/2024 03:58:33 PM

Document Has Been Signed on 06/19/2024 03:58 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:D'AMORE HEALTHCARE - S RENEFACILITY NUMBER:
306005543
ADMINISTRATOR/
DIRECTOR:		JOHN EMMAFACILITY TYPE:
772
ADDRESS:2902 S RENE DRTELEPHONE:
(714) 375-1110
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY: 6CENSUS: 5DATE:
06/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Vanessa Munoz-Behavioral Health Technician, Elissa Venegas-Operations ManagerTIME VISIT/
INSPECTION COMPLETED:
04:14 PM
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Behavioral Health Technician (BHT) Vanessa Munoz. Operations Manager (OM) Elissa Venegas arrived shortly after.

For today’s visit, LPA observed a total of five clients in care and two staff members on duty.

LPA Ramirez toured the interior and exterior portions of the facility with OM Venegas. The facility is a two story structure and is licensed for six ambulatory clients. There are a total of five bedrooms, of which three are client bedrooms, and the remaining two are being used as staff office. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detectors were tested and operational. There are a total of three restrooms. Restrooms were observed to be in good repair, to have a supply of soap, toilet paper and paper towels. LPA observed bathrooms to have hand washing signs posted. Water temperature tested between 114.8-118.3 degrees Fahrenheit.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to clients in care. Fire extinguishers were charged, and one was located by the kitchen, one in the garage, one in the living room and one by the clients' bedroom hallway/group room.

During today's visit LPA observed as the clients returned from an outing to the gym. LPA also observed that clients were participating in a group therapy session.

CONTINUED ON LIC809-C...

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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: D'AMORE HEALTHCARE - S RENE
FACILITY NUMBER: 306005543
VISIT DATE: 06/19/2024
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LPA Ramirez observed the emergency disaster and evacuation plan. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to clients in care.

For the exterior portion, LPA Ramirez observed a shaded patio area with furniture, and the grounds were free of any hazards. There are two gates in the backyard, which are self-closing and self-latching. No bodies of water were observed.

LPA reviewed four client files and two staff files. LPA interviewed clients and staff present.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with OM Venegas.

A copy of this report was provided at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC809 (FAS) - (06/04)
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