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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005729
Report Date: 08/26/2024
Date Signed: 08/26/2024 11:43:08 AM


Document Has Been Signed on 08/26/2024 11:43 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:CARE AYESHAFACILITY NUMBER:
306005729
ADMINISTRATOR:DEL ROSARIO, LESTERFACILITY TYPE:
740
ADDRESS:452 S SWIDLER PLACETELEPHONE:
(657) 281-2103
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:6CENSUS: 5DATE:
08/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Rizaldy Dimacali-Caregiver, Angie Hernandez-LicenseeTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20240514125043. LPA was greeted and granted entry into the facility by Caregiver Rizaldy Dimacali. Licensee Angie Hernandez was also present at the facility.

During the course of the complaint investigation, it was alleged that the facility manager is not present at the facility and that the manager is always out. LPA reviewed documents including the Personnel Report (LIC500) dated August 26, 2024. Per Personnel Report Licensee/manager Hernandez is scheduled to work at the facility Monday-Friday from 6:00AM-6:00PM. During the initial complaint visit on May 05, 2024 and today's visit LPA observed Licensee/manager present at the facility.

During the course of the interviews with Residents, Resident 1 (R1) reported that managers are always at the facility and stated that both managers are excellent care takers. Per R2 anything he needs the managers will get for him. During the course of the interviews the Licensee reported that she and her husband are the managers and stated that they are always at the facility. Per Licensee she and her husband live at the facility.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.



LPA Ramirez conducted an exit interview with Licensee Hernandez, and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2024
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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