306006073-3-30-2022-22-AS-RMAZ-CCAQ4E-20220307105013

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006073
Report Date: 03/07/2022
Date Signed: 03/30/2022 12:43:30 PM

Document Has Been Signed on 03/30/2022 12:43 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:	EDEN BY ENHANCE		FACILITY NUMBER:	306006073
ADMINISTRATOR:	KHOUIE, CHRISTINA		FACILITY TYPE:	772
ADDRESS:	35 MANN STREET		TELEPHONE:	(714) 475-7013
CITY:	IRVINE	STATE: CA	ZIP CODE:	92612
CAPACITY: 6		CENSUS: 0	DATE:	03/07/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Christina Khouie		TIME COMPLETED:	11:05 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at the facility was greeted by applicant and granted entry. An initial application to operate a Social Rehabilitation Facility application, for (6) capacity, (6) ambulatory, (0) non-ambulatory, and (0) bedridden clients was submitted to CCL on 09/02/2021. Average stay will be 30 days. Structure: The facility is a one-story house with 3 client’s bedrooms which are shared for 2 clients per bedroom and master bedroom is only bedroom with its own bathroom, 1 living room, 1 dining room, a restaurant style open kitchen, office/counseling, and laundry unit. The client’s bedrooms are spacious and will easily accommodate the resident’s furnishings. There is a large back yard with 2 exit ways on each side of the house with shaded patio area for clients seating. Signal system: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms are for 6 clients. Bedrooms will accommodate 6 residents with all rooms being 3 shared rooms with the master bedroom having a bathroom. CONTINUED on LIC809-C

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EDEN BY ENHANCE	FACILITY NUMBER: 306006073
	VISIT DATE: 03/07/2022

NARRATIVE

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Bedrooms Staff:
No staff bedroom, no live-in staff.

Bathrooms:
All bathrooms have a working toilet, wash basin, walk in shower.

Linens & Hygiene Supplies:
Adequate supply of linen stored in the hallway storage upstairs.

Emergency Phone Numbers, Exit Plan & Menu:
Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week.

Food Service:
Adequate food supply to meet regulations.

Smoke Detectors:
Smoke detectors and carbon monoxide alert systems are hardwired, were tested and found operational.

Appliances:
Gas four-burner stove, 2 ovens, 1 refrigerator, dish washer, microwave, washer, and dryer are clean and noted to be operational.

Toxins:
All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients will be stored and locked in storage cabinet.

Water Temperature:
Tested and recorded the water temperature measures 120.2 Fahrenheit degrees in all restrooms.
CONTINUED on LIC809-C

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EDEN BY ENHANCE	FACILITY NUMBER: 306006073
	VISIT DATE: 03/07/2022

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Medications, First-Aid Kit & Book:
Medication will be stored in a locked storage cabinet in office space inaccessible to clients. First aid kits are stored with medication cabinet.

Resident & Staff Files:
Records will be kept locked in storage cabinet located in office.

Pool/Jacuzzi & Pets:
No bodies of water in facility.

Fire Extinguisher:
Mounted in the kitchen dated March 01, 2022.

Reading Material, Games, Equipment & Materials:
The facility has board games, books, and other recreational materials for the client’s use, commensurate with the plan of operation.

Fire clearance:
Was approved on 10/25/2021.

Component III:
Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance.

Applicant was reminded that it is required to notify LPA, within 5 business days of admitting the client. This notification may be done by phone, email or fax.

Accordingly, LPA will submit file for further review to Centralized Application Burea for final determination of the application. Exit interview was conducted and a copy of this report was provided to applicant.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022

LIC809 (FAS) - (06/04)

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