306005801-7-21-2026-22-AS-RMRT-DW7PMK-20260721112629

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005801
Report Date: 07/21/2026
Date Signed: 07/21/2026 11:26:39 AM

Document Has Been Signed on 07/21/2026 11:26 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:	CARINGBRIDGE INC.		FACILITY NUMBER:	306005801
ADMINISTRATOR/ DIRECTOR:	STAN, CRISTIANA		FACILITY TYPE:	740
ADDRESS:	2421 E POWHATAN AVE		TELEPHONE:	(714) 833-5589
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92806
CAPACITY: 6		CENSUS: 5	DATE:	07/21/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Christiana Stan, Administrator		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Administrator (AD) Christiana Stan at 8am and explained the purpose of the visit. LPA explained to AD that this visit is for the 2026 calendar year and introduced self as their new assigned LPA. The facility is a two story residential home in which the first floor has five bedrooms and three bathrooms for residents. One of the Adminstrators resides on the second floor in which residents do not have access. The facility has a fire clearance for five non-ambulatory and one ambulatory in which one resident may be bedridden. The facility has an approved hospice waiver for two. Currently the facility has a census of five residents; in which three receive hospice services. A deficiency was given on April 29, 2026 and the facility has submitted a letter to the Department on April 29 2026 for an increase of the hospice waiver. Per Department communications on May 26, 2026, AD will be notified of a decision once it has been made. During the visit LPA toured the exterior of the property and there were no hazards or obstructions in pathways. There is a covered shaded seating area and there is ample space for outdoor activities. There are two exterior gates for the property and a garden. One exterior gate is locked overnight but is unlocked during the day. LPA tested the hot water temperature in three of three resident bathrooms. The hot water temperature was between 109.5 to 113.3 degrees Fahrenheit. Bathrooms had non-skid flooring and grab bars. The PUB 475 See Something, Say Something poster was observed in the office and the fire extinguisher was charged and inspected on June 8, 2026. The facility's last fire drill was on June 10, 2026. LPA tested and inspected (continued on LIC 809-C)

Alisa Ortiz
RoseMarie Ruppert
	DATE: 07/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

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: CARINGBRIDGE INC.	FACILITY NUMBER: 306005801
	VISIT DATE: 07/21/2026

NARRATIVE

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(Continued from LIC 809)

carbon monoxide and smoke alarms audio alerts. Both alarms were operational and in working order.
Kitchen appliances were operational and hazardous chemicals and sharps and knives were secured in locked drawers. The facility had two days of perishable supplies and seven days of non-perishable supplies on
hand; with additional supplies in the garage.

LPA observed resident bedrooms had the required furnishings and four of five residents had half-bed rail orders on file. The facility was clean and there were no odors detected and three of five residents were having breakfast at time of entry. Two of five residents were sleeping. LPA reviewed the centrally stored medication lists and audited medications. Per review, medications are being given as prescribed. A First Aid Kit had all of the required elements and the facility has a First Aid Manual.

LPA reviewed two of two staff files and conducted a complete review of resident records. A caregiver was in training but was not cleared on Guardian. A $100 civil penalty will be assessed since the employee just began training on July 21, 2026. A Live Scan appointment is scheduled for 11am and Administrator was advised the trainee cannot be on the premises until background check has cleared on Guardian. The Administrator's Certificate is current and will expire on June 10, 2028.

The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.
An exit interview was conducted with Administrator Christiana Stan and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D, LIC 421BG and Appeal Rights.

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/21/2026 11:26 AM - It Cannot Be Edited

Created By: RoseMarie Ruppert On 07/21/2026 at 10:57 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CARINGBRIDGE INC.	FACILITY NUMBER: 306005801
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87355(e)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation and interview, the licensee did not comply with the section cited above for one of one staff member which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/22/2026
	Plan of Correction
1 2 3 4	Administrator scheduled Live Scan appointment for new employee and will follow-up with Guardian and LPA once new employee is cleared. AD was advised employee cannot be on the premises until background clearance is complete.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:

	RoseMarie Ruppert
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

LIC809 (FAS) - (06/04)

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