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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006021
Report Date: 08/22/2024
Date Signed: 08/22/2024 10:09:07 AM

Document Has Been Signed on 08/22/2024 10:09 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SIANI ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
306006021
ADMINISTRATOR/
DIRECTOR:		ESPANA, SHARONDAFACILITY TYPE:
735
ADDRESS:4591 LARKSPUR CIRCLETELEPHONE:
(909) 767-7030
CITY:ANAHEIMSTATE: CAZIP CODE:
92807
CAPACITY: 4CENSUS: 4DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Sharonda EspanaTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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Licensing Program Analysts (LPAs) Claudia Gutierrez and Samer Haddadin made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPAs met with Administrator (AD) Sharonda Espana and explained the purpose of the inspection.

During the inspection, LPAs and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:

This is a one-story home with four client bedrooms, one staff office, one activity room, three bathrooms, and attached two-car garage. All client bedrooms had the required furnishings. LPAs observed all client beds had linens and blankets. LPAs observed all windows were screened. The backyard has a shaded sitting area. LPAs observed two clients present at the facility, as one client was away at day program, and another client was at work. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 112.8 degrees Fahrenheit.

LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service tag dated February 1, 2024. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to clients and stored in a locked closet. Medication closet was also observed to be locked. LPAs reviewed four client files and four staff files. LPAs interviewed clients and staff present.

Based on the observations made during today’s inspection, no deficiencies are 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: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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