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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005812
Report Date: 11/05/2024
Date Signed: 11/05/2024 10:47:07 AM

Document Has Been Signed on 11/05/2024 10:47 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:VASS SENIOR CAREFACILITY NUMBER:
306005812
ADMINISTRATOR/
DIRECTOR:
VASS, AGOSTONFACILITY TYPE:
740
ADDRESS:10402 LADERA SENDATELEPHONE:
(714) 624-5277
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
11/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Melinda VassTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility to conduct a Required - 1 year inspection. LPA identified herself and was granted entry into the facility by Staff Melinda Vass. Facility appears clean, safe and sanitary. Administrator (AD) Agoston Vass' certificate expires on 07/02/2025.

One Resident and 2 staff were present during today's visit. LPA, along with Staff toured the physical plant. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each Resident comfortably. Bathroom was checked, toilets/water faucets worked properly and showers are free of mold/mildew. Hot water temperature is within regulatory requirements. Bath towels, toiletries and personal hygiene supplies are adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Kitchen is clean and organized. Perishable and non-perishable food supply was checked and adequately stocked. LPA observed sharps and cleaning supplies are inaccessible to the residents. Facility is equipped with sprinklers and smoke detectors and carbon monoxide detector are operational. Fire extinguisher was fully charged and mounted. No bodies of water were observed outside. Walkways around the home were clear of hazards. Emergency/Fire Drills are conducted but not documented. LPA observed emergency supplies including food and water. LPA reviewed 2 Resident files and 1 staff file. Medication was observed to be in a centrally stored location and medication reviewed appeared to have been dispensed accurately.

Based on the observations made during today’s visit, no deficiency is being cited. This report was discussed with the facility staff and a copy of LIC809 and LIC9102 Advisory were sent to email on file.
Lourdes MontoyaTELEPHONE: (714) 748-2936
Lydia MartinezTELEPHONE: (714) 705-6004
DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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