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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006043
Report Date: 10/30/2024
Date Signed: 10/30/2024 04:00:36 PM

Document Has Been Signed on 10/30/2024 04:00 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:C-P RESIDENTIAL HOMESFACILITY NUMBER:
306006043
ADMINISTRATOR/
DIRECTOR:		PEREZ, CELIAFACILITY TYPE:
735
ADDRESS:894 SOUTH BARNETT ST.TELEPHONE:
(714) 519-4239
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 4CENSUS: 3DATE:
10/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Celia PerezTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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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 were greeted and granted entry by Administrator (AD) Celia Perez 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, two 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 one client present during the visit, watching television in their respective bedroom. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 104.0-110.1 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 service tag indicating it was last serviced on November 2, 2024. AD stated they are aware the fire extinguisher is due for servicing and will have it serviced in the next few days. 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. Medication cabinet was observed to be locked. LPAs reviewed three of three client files and two staff files. LPAs interviewed staff and client 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: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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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