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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006075
Report Date: 02/26/2025
Date Signed: 02/26/2025 01:29:16 PM

Document Has Been Signed on 02/26/2025 01:29 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:HOME SWEET HOMECAREFACILITY NUMBER:
306006075
ADMINISTRATOR/
DIRECTOR:		MENJIVAR, YESENIAFACILITY TYPE:
735
ADDRESS:8722 KATELLA BLVDTELEPHONE:
(714) 827-3990
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 4CENSUS: 0DATE:
02/26/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:08 PM
MET WITH:Yesenia Menjivar, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On today’s date, Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst (LPA) Rose Ruppert met with Licensee (LE), Yesenia Menjivar, for the purpose of discussing current operations at the facility after an annual visit on February 6, 2025.

The following was discussed:

  • Concerns regarding recent Annual visit which resulted in: one Type A, two Type Bs, two Technical Violations and two Technical Assistances
  • Licensee’s requirements to have the following documents on file: signed Admissions Agreements to comply with Title 22, signed Physician’s Reports for each client with the new facility name and facility number
  • Licensee’s requirement to complete an Infection Control Plan
  • Licensee’ responsibility to ensure physical plant is maintained. This includes having hot water temperatures between 105 to 120 degrees Fahrenheit, securing cleaning solutions in the garage, and having emergency lighting in hallways to non-private bathrooms
  • Licensee’s requirement to conduct a fire drill quarterly for each shift with documentation stating the type of emergency covered by the drill and staff members’ names who participated in the drill

The Licensee stated the following during today’s meeting:
  • LIcensee realized she was including clients in fire drills and not including staff. Licensee understood staff are required to participate in quarterly fire drills per Title 22 regulations.
  • Licensee will have an Infection Control Plan reviewed by TSP on February 27, 2025 and will submit to the Department.

(Continued on LIC 809-C)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HOME SWEET HOMECARE
FACILITY NUMBER: 306006075
VISIT DATE: 02/26/2025
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(Continued from LIC 809)

During the meeting the Technical Support Program (TSP) referral, by LPA Fred Arias, was discussed and the Licensee has agreed to participate.

An exit interview was conducted with Licensee Yesenia Menjivar and a copy of this report was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC809 (FAS) - (06/04)
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