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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005883
Report Date: 12/06/2021
Date Signed: 12/06/2021 11:59:16 AM

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:B & B HOMECAREFACILITY NUMBER:
306005883
ADMINISTRATOR:CASTILLO, LIBERTY N. DELFACILITY TYPE:
740
ADDRESS:3173 W POLK AVENUETELEPHONE:
(714) 886-2280
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:6CENSUS: 4DATE:
12/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Liberty CastilloTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA met with Administrator Liberty Castillo. LPA and Administrator toured the facility. Facility has 6 bedrooms and 3 bathrooms. LPA observed all bedrooms had the required furnishings and had enough space to accommodate the residents and their belongings. All 3 bathrooms were clean and operational. Water temperature measured 107.0 degrees Fahrenheit. LPA observed a 2 day supply of perishable food and a 7 day supply of non-perishable food supply on hand in the kitchen. The kitchen is cleaned and organized. LPA observed the knives and sharp objects are kept locked in a kitchen drawer. Smoke detectors/carbon monoxide detectors tested operational. LPA toured the backyard. There is a sitting area with a table, chairs and an umbrella to sit outside. There is a small water fountain on the side of the house. There is a small metal shed that is used to store patio furniture. Both exit gates are operational. No obstacles or hazards observed in the backyard. Facility has a mitigation plan that is pending approval. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
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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