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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005780
Report Date: 08/24/2020
Date Signed: 08/24/2020 04:55:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CANDLEBERRY CAREFACILITY NUMBER:
306005780
ADMINISTRATOR:ROSARIO, ROBERTO DELFACILITY TYPE:
740
ADDRESS:4216 CANDLEBERRY AVE.TELEPHONE:
(949) 290-6006
CITY:SEAL BEACHSTATE: CAZIP CODE:
90740
CAPACITY:6CENSUS: 0DATE:
08/24/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Uldarico "Rico" Almiranez, LicenseeTIME COMPLETED:
04:19 PM
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Licensing Program Analyst (LPA) Rosie Quiroz conducted an announced Pre-Licensing follow up virtual tele- visit for purpose of reviewing the items that were identified as needing correction during the initial Pre-Licensing evaluation with Component III Orientation dated 08/13/2020.Today's tele-visit was conducted via phone Face-Time virtual technology with Licensee Udarico "Rico" Almiranez at Candleberry Care due to the Coronavirus Pandemic and precautionary measures.

An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 03/30/2020 for a capacity of 6 Non-Ambulatory residents.

On or about 3:39pm, LPA Quiroz along with Licensee Almiranez began the virtual inspection to review the items requiring attention and the following was observed:

  • A thermometer to test resident and staff body temperature
  • Mattress pads for 6 of 6 resident beds
  • Emergency preparedness supplies in garage area
  • Fireplace protection screen
  • COVID-19 posters displayed through out facility in pertinent areas

All items reviewed during the visit are now in compliance. Facility appears ready for licensure. The licensee will be granted upon completion of a final review and approval from Central Applications Bureau.

An exit interview was conducted with Licensee Uldarico "Rico" Almiranez, and a copy of this report was provided at the time of this visit via email due to COVID-19 Precautionary measures. Licensee Almiranez agreed to print, sign and mail original copy to Orange County Regional Office timely.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2020
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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