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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005572
Report Date: 03/20/2025
Date Signed: 03/20/2025 10:51:17 AM

Document Has Been Signed on 03/20/2025 10:51 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:OLIVE TREE HOME CAREFACILITY NUMBER:
306005572
ADMINISTRATOR/
DIRECTOR:
DIAZ, FRANCISCAFACILITY TYPE:
740
ADDRESS:638 N JAMES PLTELEPHONE:
(714) 726-3724
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
03/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Francisca DiazTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Samer Haddadin made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Francisca Diaz and explained the reason for the visit. LPA toured the interior and exterior portions of the facility with AD and observed the following:

Facility is a single-story home with 7 bedrooms (1 room is for staff), 6 bathrooms, living room, dining room, family room, laundry room, eat in kitchen and a two-car attached garage. Francisca Diaz's Administrator's Certificate expires on 10/07/2026.

Resident rooms were provided with furniture, chair and clean Lenin adequate storage space, and kept free of tripping hazards. Manual smoke detectors, carbon monoxide and exit alarms were tested to be operational. Bathrooms were observed to be in good repair and provided with grab bars and hot water was measured at 119.9 degrees Fahrenheit. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements.

Fire extinguisher was observed fully charged and indicator in the green zone. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards and ample space for activities. The facility has a pool that is fenced and is inaccessible to residents in care

Kitchen was in good repair with cleaning supplies and sharp items inaccessible to residents in care. Medications are kept locked separately in hallway. LPA reviewed two residents’ files and medications with no discrepancies observed. All files of staff and residents contained all required documentation. Upon review of records, the facility is up to date with required quarterly fire drill, which was last conducted on January 23rd, 2025 LPA observed pub-457 poster posted and within regulatory required size.

No deficiencies were noted during today's inspection visit. An exit interview was conducted, and a copy of this report was provided the administrator.

Alisa OrtizTELEPHONE: (714) 703-2855
Samer HaddadinTELEPHONE: (714) 790-2096
DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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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