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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005736
Report Date: 02/24/2025
Date Signed: 02/24/2025 04:44:51 PM

Document Has Been Signed on 02/24/2025 04:44 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:ELD HEALTHCAREFACILITY NUMBER:
306005736
ADMINISTRATOR/
DIRECTOR:		TINA MENENDEZFACILITY TYPE:
740
ADDRESS:985 NORTH SHAFFER STREETTELEPHONE:
(949) 375-6635
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
02/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Mayra Bermudez TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On February 24th, 2025 Licensing Program Analyst (LPA) William Vanegas conducted an unannounced inspection for the purposes of an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry by Care Giver (CG) Mayra Bermudez. LPA Vanegas explained the purpose of the visit and began a tour of the home, and observed the following.

This is a one storied home with five bedrooms with five and a half bathrooms. Five of which are used for resident use and the half bathroom is used for guest and employees. The facility also has a detached single car garage. LPA Vanegas observed kitchen area to be clean and free of any mildew and debris. LPA Vanegas observed a two day supply of perishable food and a seven day supply of non-perishable food. LPA Vanegas observed there to be a dishwasher, gas stove, microwave, washer and dryer; that all appeared to be in good repair, and tested to be operational.

LPA Vanegas observed resident bathrooms to be clean and free of any mildew or debris. Water faucets and toilets tested to be operational. Bathrooms had all required furnishings such as a shower chair, grab bars, and slip resistant matts. Water tested between 109.3 and 113.5 degrees. LPA Vanegas observed all smoke detectors and carbon monoxide detectors to be operational and in good repair. LPA Vanegas observed fire extinguisher to be fully charged and up to date.

LPA Vanegas observed all resident rooms to be clean and free of any debris. All resident rooms had required furnishings such as chest drawers, a lamp, screened windows, a bed, and clean linens in good repair meaning no strains or tears. LPA Vanegas observed outside of the facility to be clean and free of any obstructions along the emergency exits. Backyard is clean and provides a shaded sitting area, and is big enough to participate in outdoor activities.
CONTINUED ON LIC809C
Armando J LuceroTELEPHONE: (714) 703-2866
William VanegasTELEPHONE: (714) 497-7621
DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
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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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: ELD HEALTHCARE
FACILITY NUMBER: 306005736
VISIT DATE: 02/24/2025
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LPA Vanegas reviewed four staff files and four resident files all files (Staff and Resident) Had all required documentation, and staff training was all up to date and documented.

LPA Vanegas observed sharps, toxins, and medications all to be locked, and inaccessible to residents in care. LPA Vanegas observed medications to be documented and administered per physicians orders. Based on observations made during today's visit no deficiencies will be cited per title 22 chapter six of the California Code Of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2866
LICENSING EVALUATOR NAME: William VanegasTELEPHONE: (714) 497-7621
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC809 (FAS) - (06/04)
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