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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006073
Report Date: 07/30/2024
Date Signed: 07/30/2024 12:44:32 PM

Document Has Been Signed on 07/30/2024 12:44 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:EDEN BY ENHANCEFACILITY NUMBER:
306006073
ADMINISTRATOR/
DIRECTOR:		RUTH KHAYFACILITY TYPE:
772
ADDRESS:35 MANN STREETTELEPHONE:
(949) 503-3553
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY: 6CENSUS: 3DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Veronica Hernandez Lazaro, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On this day, Licensing Program Analysts (LPA) Kevin Saborit-Guasch & Samer Haddadin made an unannounced visit to the facility for the purpose of conducting a Required Annual Inspection. LPAs were greeted and granted entry by facility staff after introducing themselves and stating the purpose of the visit. Program Manager Veronica Hernandez Lazaro was also present to assist.

During the inspection, LPAs accompanied by staff conducted a tour of the inside and outside of the facility:
The facility is a one-story house with three shared client bedrooms, one shared bathroom and one en-suite bathroom, common areas and a separate staff office. All client bedrooms had the required furnishings. LPAs observed all client beds had linens and blankets. The HVAC intake in the bedrooms' hallway is observed to be dusty during the walkthrough. Bathrooms faucets and toilets were operational. Water temperature tested to be within the appropriate temperature range. LPAs observed all windows were screened and not equipped with security window bars. The backyard has a shaded sitting area equipped with outdoor furniture. The canopy providing shade is observed to be torn, and was explained to have been damaged by an animal on July 10, 2024. The canopy is pending replacement at the time of the visit. There are no bodies of water on the premises. Three clients are currently admitted to the facility and present at the time of the visit.

LPAs observed and reviewed the facility's emergency disaster plan and a posted sketch with means of exiting and emergency phone numbers listed and posted in the facility's courtyard. Menu was also posted and visible. Meals are catered and delivered to the facility for lunches and dinners. LPAs observed the facility does have a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations.

CONTINUED ON FORM LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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Document Has Been Signed on 07/30/2024 12:44 PM - It Cannot Be Edited


Created By: Kevin Saborit-Guasch On 07/30/2024 at 12:15 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: EDEN BY ENHANCE
FACILITY NUMBER: 306006073

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
81087(a)
Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation made during the visit, the licensee did not comply with the section cited above in two instances as a torn canopy and dusty HVAC intake were observed. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2024
Plan of Correction
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Licensee will proceed to replace the torn canopy and clean the HVAC intake. Proof of the corrections to be provided to LPAs before the plan of corrections 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:Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: EDEN BY ENHANCE
FACILITY NUMBER: 306006073
VISIT DATE: 07/30/2024
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CONTINUED FROM FORM LIC809

Smoke detectors and carbon monoxide detectors tested operational. Fire extinguishers were observed to be fully charged with up-to-date maintenance. Sharps were observed to be kept locked and inaccessible. All and any toxic chemicals, cleaning solutions, laundry detergent and disinfectants are also inaccessible to clients. Laundry detergent is available to client for personal laundry upon request with staff supervision.

Medication cabinet was observed to be locked in staff room. LPAs reviewed three client files and two staff files for staff members present at the time of the visit. Background clearance and staff association status was verified for all active staff members and terminated staff members were separated from the facility roster in Guardian during the visit. LPAs interviewed two staff members and two clients during the visit.

Based on the observations made during the visit, one type B deficiency was cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
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