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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005634
Report Date: 08/01/2024
Date Signed: 08/01/2024 04:15:10 PM

Document Has Been Signed on 08/01/2024 04:15 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:UNIQUE CARE 4FACILITY NUMBER:
306005634
ADMINISTRATOR/
DIRECTOR:		NASSIF, JOSEPHFACILITY TYPE:
735
ADDRESS:1418 BAKER AVETELEPHONE:
(714) 853-1094
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 6CENSUS: 5DATE:
08/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:14 PM
MET WITH:Joseph NassifTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On August 1, 2024 at 1:14PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Licensee (LI) Joseph Nassif and explained the purpose of the visit.

The facility is licensed to operate for six (6) ambulatory clients. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) client bedrooms, one (1) staff bedroom, three (3) bathrooms, detached garage, living room, dining room, kitchen, and outdoor covered patio area.

LPA Kim toured inside and outside of the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each client’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Client Room 1, Client Room 2, Client Room 3, Client Room 4, and Staff Room. Bathrooms were found to be clean and operational. The water temperature measured between 108.6 degrees F and 115.8 degrees F at all client bathrooms. A comfortable temperature of 82 degrees F was maintained in the facility.

LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage area for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency Food, Emergency Water, and Emergency supplies for the clients are stored in the garage. A working telephone (714-853-1094) remains available. The facility has smoke/carbon monoxide detectors that were operable. First Aid Kit contained all the necessary elements. The Facility has one (1) fire extinguisher in the living room area that is fully charged and was serviced January 5, 2024.

Evaluation Report Continues on LIC 809-C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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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: UNIQUE CARE 4
FACILITY NUMBER: 306005634
VISIT DATE: 08/01/2024
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During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and client. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. Fire safety drills are conducted two times per month and the earthquake drills are conducted monthly. The last fire safety drill was conducted July, 25, 2024. The last earthquake drill was conducted on July 25, 2024.

LPA Kim conducted an audit of five (5) clients (C1-C5) files, four (4) staff (S1-S4) files, P&I client funds, and medication and medication administration record that were all in order and complete. LPA conducted two (2) staff interviews and three (3) client interviews.

Based on observations made, no deficiencies were observed or cited at this time.



An exit interview was conducted, and a copy of this report was provided to Licensee Joseph Nassif.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
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