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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005994
Report Date: 05/15/2024
Date Signed: 05/15/2024 10:46:35 AM

Document Has Been Signed on 05/15/2024 10:46 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ARCHER 2 HOUSEFACILITY NUMBER:
306005994
ADMINISTRATOR/
DIRECTOR:
LOPEZ, ANICIAFACILITY TYPE:
735
ADDRESS:320 S ARCHER STTELEPHONE:
(714) 692-0344
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 4DATE:
05/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Early Maglaya - House ManagerTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of conducting a required annual inspection. Upon arrival, LPA observed no one to be present at the facility. LPA called Administrator. AD notified LPA that all clients were at Day Program and staff were out grocery shopping. AD redirected a staff member back to the facility. LPA departed the facility.

LPA returned to the facility and was greeted and granted entry into facility by House Managers Early Maglaya and Matilde Ventura.
The facility is a one-story home with four client bedrooms, two bathrooms, kitchen, dining room, living room, staff room, backyard with pool and attached 2-car garage. LPA noted four out of four clients were away at day program. All client rooms had the required elements, including bed, chair, closet space and ample lighting. Facility has extra linens for clients in the hallway closet. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured at 118.3 and 116.4 degrees Fahrenheit in the bathrooms. LPA observed facility has emergency food and water supply. LPA noted Fire Extinguishers were last serviced on 3/22/2024. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in cabinets in the kitchen. Knives are locked up separate from toxic chemicals. Medication for each client is kept locked in a cabinet in the kitchen. The backyard has a pool that is six feet deep. The pool is surrounded on three sides by a six-foot tall brick wall. The side of the pool closest to the house is fenced in by a five-foot tall iron fence. The vertical bars on the fence are separated by four inches of space. The bottom of the fence is four inches from the ground. The fence's door is locked and latched. Exit gate is unlocked. LPA observed exit gate to be unobstructed. LPA reviewed two of the four client files and four staff files. LPA also reviewed medication for two out of four clients. LPA reviewed P&I funds for two out of four clients.

Based on today's inspection, no deficiencies are being issued. An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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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