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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005807
Report Date: 05/19/2022
Date Signed: 05/19/2022 10:27:59 AM


Document Has Been Signed on 05/19/2022 10:27 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
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:
(714) 233-5392
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 6DATE:
05/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Claudia OlteanuTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit to conduct the required annual (mitigation) inspection. LPA was greeted and granted entry by Caregiver Hilarion Alfaro after completing the Coronavirus 2019 (COVID-19) screening procedure. LPA stated the purpose of the visit and began the tour of the facility with Caregiver Mary Christine Alfaro. Administrator (Admin) Claudia Olteanu joined at the end of the tour at 10:00 am.

This facility is a single level structure and licensed for two ambulatory and four non-ambulatory of which one may bedridden in Room #3 only; and has a hospice waiver for two. There is one resident under hospice care. As of today, LPA observed all 4 residents resting and watching television in their respective bedrooms. At 9:41 am, LPA toured the interior and exterior portions of the facility. LPA observed the required department postings at the front door and all around the facility as well as hand washing signs in the restrooms. LPA observed all restrooms had ample soap/sanitizer, paper towels, and appeared clean. Bathrooms were provided with grab bars and a non-skid floor mat. Hot water was measured at 111.3 degrees Fahrenheit in Bathroom #1 and 109.7 degrees Fahrenheit in Bathroom #2. Residents' bedrooms appeared clean and sanitary and had all required components. Smoke detectors, carbon monoxide, and auditory exit alarms tested operational. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Sharp items, medications, and cleaning supplies were inaccessible to the clients in care. For the exterior portion, facility had patio furniture under ample shading. LPA observed the emergency disaster and evacuation plans. Facility does have back-up emergency food and water supply and has a 30 day supply of PPEs. The First Aid Kit met all the required elements. LPA discussed Assembly Bill 665 that requires a licensee of any adult or senior care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. LPA observed a laptop was provided for resident use.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: GARDEN OF EDEN GUEST HOME
FACILITY NUMBER: 306005807
VISIT DATE: 05/19/2022
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LPA reviewed the approved COVID-19 mitigation plan of the facility. No deficiency cited in this review as per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Claudia Olteanu, and a copy of this report was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022
LIC809 (FAS) - (06/04)
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