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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006036
Report Date: 10/23/2024
Date Signed: 10/23/2024 11:15:13 AM

Document Has Been Signed on 10/23/2024 11:15 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SOCAL EMPOWERED LLCFACILITY NUMBER:
306006036
ADMINISTRATOR/
DIRECTOR:
PERRAIE, JAMESFACILITY TYPE:
772
ADDRESS:23671 BRASILIATELEPHONE:
(888) 630-3860
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 6DATE:
10/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:20 AM
MET WITH:James Perraie- AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1 Year Annual Evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Behavioral Health Technician (BHT) Carina Prado and explained the reason for the visit. LPA met with Program Director Susan Kue and Administrator (Admin) James Perrraie upon their arrival.

This facility is a two-story home in a residential neighborhood comprised of three shared client bedrooms and two client bathrooms with an additional bathroom designated for employees and guests on the 1st floor. LPA observed all common areas including the attached two car garage which doubles as a laundry room/medication office. LPA observed the facility was clean, organized, and operational. LPA observed the client bedrooms had all the required elements with ample lighting. LPA inspected the three bathrooms. The showers, faucets, and toilets were sanitary and in operating condition. The hot water temperature in the two client bathrooms measured at 109.4 and 106.7 degrees Fahrenheit. LPA toured the outside grounds. The passageways were clear of obstruction. The exit gate was self-closing and self-latching. The swimming pool gate was secured. LPA observed sufficient clean supply of linens. LPA observed ample two-day supply of perishables and seven-day supply of non-perishable food. LPA observed the emergency food/water. The carbon monoxide and smoke detectors were tested and operational. The two fire extinguishers were securely mounted and serviced on October 13, 2024. Medications, sharps, and toxins were locked and inaccessible to the clients. LPA reviewed the Emergency Disaster Plan (LIC610D), evacuation logs, and observed a current liability insurance. LPA reviewed six out of six client files and two staff files. No discrepancies noted. LPA audited medications for six out of six clients. No discrepancies noted. LPA reviewed the six out of six clients' funds. No discrepancies noted. No interviews were conducted as all clients were on an outing at the time, however one staff interview was conducted during today's visit.
Based on today's observations, no deficiency is being cited as per the Title 22 Division 6 Chapter 2 of the California Code of Regulations. An exit interview was conducted with Administrator James Perraie, and a copy of this report was provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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