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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005807
Report Date: 06/16/2020
Date Signed: 06/16/2020 01:30:49 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:GARDEN OF EDEN GUEST HOMEFACILITY NUMBER:
306005807
ADMINISTRATOR:OLTEANU, CLAUDIAFACILITY TYPE:
740
ADDRESS:11661 PURYEAR LANETELEPHONE:
(949) 232-9619
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 0DATE:
06/16/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Applicant Claudia OlteanuTIME COMPLETED:
11:30 AM
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At 10:00 AM, Licensing Program Analyst (LPA) Mike Barrett contacted the facility via FaceTime application, using iPhone technology, to commence a pre-licensing inspection due to COVID-19 and pre-cautionary measures. LPA identified himself and discussed the purpose of the announced video call and spoke with Applicant, Claudia Olteanu. The facility contains 7 bedrooms with 3 full bathrooms and is a single-story building with a 2-car garage. This inspection was for a new facility and therefore did not have any residents.

The inspection was conducted as follows:

Physical Plant:
At 10:10 AM, LPA Barrett conducted the virtual inspection and toured the inside and outside of this facility with Applicant, including but not limited to the kitchen, common areas, laundry room, garage, bathrooms, bedrooms, back patios and walkways. LPA observed that the facility was clean, there were no obstructions to the interior or exterior walkways and the backyard gate was observed to be self-closing and self-latching. The kitchen was clean, and knives other sharp kitchen utensils were to be stored in a locked drawer. There were smoke/carbon monoxide detectors installed throughout common areas as well as all of the bedrooms, which were centrally wired, tested and observed to be in good operation. LPA observed that there were alarms installed on all of the exit doors that were tested and observed to be functional. Fire extinguishers were located by the kitchen, at the end of the hall by the bedrooms and by the office and were observed to be appropriately charged and mounted. Centrally Stored medications were planned to be stored in a locked pantry that was located in the kitchen which also contained the complete first aid kit .

Bedrooms:
Bedrooms were observed to have made beds, bedroom furniture, appropriate lighting and exit doors were free of obstructions.

Continued on page 2.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Michael BarrettTELEPHONE: (714) 703-2847
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: GARDEN OF EDEN GUEST HOME
FACILITY NUMBER: 306005807
VISIT DATE: 06/16/2020
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Continued from page 1.

Bathrooms:
Bathrooms were equipped with grab bars and non-skid mats in the shower stalls and the water temperatures from the faucets was adjusted to within 105 and 120 degrees F.

Supplies:
There was a sufficient supply of toilet paper and hand soap as well as a sufficient stock of linens located in the hall closet.

Food Service:
There were no residents in the facility at the time of this inspection however LPA and Applicant discussed the regulation of 2 day perishable and 7 day non-perishable on food supply on hand at all times.

Records:
There were no residents in the facility during this inspection however, the resident and staff files were planned to be kept in the locked closet in the office.

Administration:
LPA observed and reviewed the facility’s Emergency Disaster Plan, Resident Personal Rights and “Let-Us-No” poster posted on the informational wall located in the dining room.

Due to the Administrator was currently managing two (2) other facilities that were observed to be in substantial compliance with Regulations, LPA waived the Component III Orientation. Applicant stated that the facility does not plan to advertise for dementia care at this time.

An exit interview was conducted with Applicant, Claudia Olteanu via telephone and a copy of this repor twas provided to Applicant Olteanu via email and an electronic email read receipt confirms receiving this documents.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Michael BarrettTELEPHONE: (714) 703-2847
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020
LIC809 (FAS) - (06/04)
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