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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005943
Report Date: 04/08/2024
Date Signed: 04/08/2024 02:10:27 PM

Document Has Been Signed on 04/08/2024 02:10 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:MANDEL HOUSEFACILITY NUMBER:
306005943
ADMINISTRATOR/
DIRECTOR:		YVETTE DORANFACILITY TYPE:
735
ADDRESS:2220 CONCORD STREETTELEPHONE:
(818) 782-2211
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 0DATE:
04/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:38 AM
MET WITH:Ivy ContrerasTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Ivy Contreras and explained the reason for the visit. LPA and Administrator toured the facility. Facility is a single story house with 6 bedrooms, 3 bathrooms, living room with a fireplace that is screened, dining room, family room, kitchen and an attached 2 car garage. No clients were present during the visit. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the stove lights unassisted. LPA observed the fire extinguisher in the kitchen is fully charged. LPA observed medications are kept locked in a kitchen cabinet. Knives, sharp objects and cleaning supplies are kept locked in the garage. The garage is kept locked and used for storage. LPA inspected the client rooms. LPA observed the client rooms had the required furnishings. LPA observed all of the client beds had the required linens. The hot water measured from 105.9 to 107.2 degrees Fahrenheit in all 3 bathrooms. All 3 bathrooms were clean and operational. The smoke detectors/carbon monoxide detectors tested operational. LPA toured the backyard. The backyard has a seating area for clients. No bodies of water observed. The exit gate is latched and self closing. No obstacles or hazards observed in the backyard. LPA reviewed 5 client files, no discrepancies observed. LPA reviewed 5 out of 5 client medications, no discrepancies observed. LPA reviewed 3 staff files, no discrepancies observed. LPA observed that at this time the facility has no qualified Administrator who is currently certified (has an active certificate). The Administrator reported she is waiting for her initial certificate and has submitted the training documents to be verified by the Agency. No obstacles or hazards observed inside the facility. LPA consulted with the Administrator concerning reporting requirements, administrator requirements, the use of Guardian and document requirements for the facility. Deficiency is being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2024
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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Document Has Been Signed on 04/08/2024 02:10 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 04/08/2024 at 01:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MANDEL HOUSE
FACILITY NUMBER: 306005943

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85064(b)
Administrator Qualifications and Duties
(b) All adult residential facilities shall have a qualified and currently certified administrator.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above. LPA observed the facility does not have a currently certified administrator in which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/16/2024
Plan of Correction
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Licensee agrees to have a qualified and currently certified administrator for the facility and to have them associated to the facility. Licensee to forward proof to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2024


LIC809 (FAS) - (06/04)
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