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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005779
Report Date: 06/09/2026
Date Signed: 06/09/2026 03:57:43 PM

Document Has Been Signed on 06/09/2026 03:57 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:PATRICIA HOMEFACILITY NUMBER:
306005779
ADMINISTRATOR/
DIRECTOR:		COLLANTES, DELIA B.FACILITY TYPE:
735
ADDRESS:10881 PATRICIA DRIVETELEPHONE:
(714) 624-9933
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 4CENSUS: 2DATE:
06/09/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Dante BenedictoTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced annual inspection of the facility. Upon arrival, LPA Tea was greeted by direct care staff and granted entry. Administrator (AD) Dante Benedicto arrived shortly to assist with the visit. The facility is licensed to serve two ambulatory and two non-ambulatory clients and has two clients in care at the time of the inspection.

LPA Tea reviewed two client files and two staff files. All files were complete and contained the required documentation. The Administrator Certificate is valid through July 15, 2027.

LPA Tea, accompanied by the administrator, conducted a tour of the facility, including the physical plant, food service areas, and first aid supplies. The facility is a single-story home consisting of three client bedrooms, activities room, two bathrooms, a kitchen, dining area, living room, and an attached garage.

The facility was observed to be clean, safe, and well-maintained. Smoke detectors and carbon monoxide detectors were operational in both common areas and bedrooms. Client bedrooms were appropriately furnished with beds, linens, and sufficient storage space. Bathrooms were in good repair, with functioning fixtures, secure grab bars, and showers free of mold or mildew. The hot water temperature measured approximately 118.3°F. Hygiene supplies, including towels and toiletries, were adequately stocked.

Common areas were free of hazards and unobstructed. The first aid kit was complete and included all required items. The kitchen was clean and fully operational, with an adequate supply of perishable and non-perishable food. Sharp objects were securely stored, and all toxic substances were locked. Fire extinguishers were fully charged. The most recent disaster drill was conducted on March 26, 2026.

(Annual inspection continued on LIC9099C)

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: PATRICIA HOME
FACILITY NUMBER: 306005779
VISIT DATE: 06/09/2026
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Outdoor areas were also inspected and found to be safe and well-maintained, with shaded seating available. The right-side gate was self-latching and in good working order. Emergency food and supplies were stored in the kitchen, with water stored in the activities/family room.

During the visit, LPA Tea observed clients going for walks around the neighborhood, engaging in snacks, and resting. The facility provides activities based on individual preferences, including puzzles, sensory games, going out for walks, and community outings such as going to out to eat and to the park.

Medication storage and administration practices were reviewed. Medications were securely stored in a locked cabinet and administered in accordance with physician orders. Personal and Incidental (P&I) funds were reviewed and found to be in compliance with department standards.

LPA Tea conducted interviews with clients and staff regarding the quality of care and services provided.

Based on observations and record reviews conducted during today’s inspection, no deficiencies were cited in the areas evaluated in accordance with Title 22, Division 6 of the California Code of Regulations.

This report was reviewed with Administrator Dante Benedicto. Copies of LIC809, LIC809-C, LIC858, and LIC859 were provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC809 (FAS) - (06/04)
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