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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005885
Report Date: 12/30/2024
Date Signed: 12/30/2024 12:30:44 PM

Document Has Been Signed on 12/30/2024 12:30 PM - 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:MON JOLI CHATEAUFACILITY NUMBER:
306005885
ADMINISTRATOR/
DIRECTOR:		SOONTHORNPONG, SUPARBFACILITY TYPE:
735
ADDRESS:1330 S FALCON STREETTELEPHONE:
(714) 774-7652
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 5DATE:
12/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Saadieh KhalilTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 12/30/2024 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of an annual visit. Upon arrival LPA Vanegas was greeted and granted entry to the facility by house manager Saadieh Khalil, LPA Vanegas explained the purpose of the visit and set up equipment once entry was granted. LPA Vanegas began a tour of the facility at 8:12AM and observed the following

This is a one storied home with seven bedrooms, one of which is a staff room that is not used for live in staff, but only used for them to take a break as needed. The facility has two bathrooms one client bathroom, and one staff bathroom. LPA Vanegas observed the kitchen to be clean and sanitary. LPA observed gas stove, dishwasher, and microwave to all be operational. LPA Vanegas observed there to be an operational washer and dryer. LPA observed a two day supply of perishable food, and a seven day supply of non-perishable food. LPA Observed a sufficient amount of emergency water available.

LPA observed sharps, chemicals, and liquid detergents to be secure and inaccessible to clients in care. LPA observed client's resting and watching television in their respective areas. LPA Vanegas observed client bedrooms to be clean and sanitary and contained all required furnishings such as a lamp, night stand, chest drawers, closet space, and bed. Linens were observed to be clean and in good repair, meaning no tears or strains. LPA observed resident bathrooms to be clean, free of debris, and mildew. Water faucets, and toilet tested to be operational, water temperature tested to be between 109.0-110.4 degrees.

LPA Vanegas observed smoke detectors and carbon monoxide detectors to be fully operational and in good repair. Fire extinguishers were observed to be fully charged and up to date. LPA Vanegas toured the outside of the facility and observed there to be a shaded sitting area available for client use. Ramps and exits are all clear of obstructions and no hazards were observed to be present.

CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MON JOLI CHATEAU
FACILITY NUMBER: 306005885
VISIT DATE: 12/30/2024
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LPA Vanegas reviewed three staff files and five client files. All files have all required paperwork, and no files were missing. All staff are up to date on required training and no deficiencies will be cited. LPA Vanegas reviewed PNI with staff member Saadieh Khalil.

Medications were observed to be in a locked cabinet and inaccessible to clients in care. Medication Administration Record (MAR) was reviewed and per LPA Vanegas review medications are being administered per physicians orders.

Based on the observations made during today’s inspection, deficiencies are not being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility..
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC809 (FAS) - (06/04)
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