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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006137
Report Date: 04/30/2024
Date Signed: 04/30/2024 03:42:29 PM

Document Has Been Signed on 04/30/2024 03:42 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:REEFTON GUEST HOMES, INC.FACILITY NUMBER:
306006137
ADMINISTRATOR/
DIRECTOR:		RIVERA, MARIA ROSALINAFACILITY TYPE:
735
ADDRESS:6642 REEFTON AVENUETELEPHONE:
(714) 679-8522
CITY:CYPRESSSTATE: CAZIP CODE:
90630
CAPACITY: 4CENSUS: 4DATE:
04/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Administrator, Maria RiveraTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 4/30/2024, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by Staff and granted entry after stating the purpose of the visit. Assistant Administrator Wyleen Rivera was present and assisted with the facility inspection on today's date. Administrator Maria Rivera arrived during visit and joined in inspection visit.

The facility is licensed for four (4) ambulatory clients. Facility is a single story with a two-car garage home. The facility has four bedrooms (three client rooms & one staff room) and two full bathrooms.

At around 11:45, LPA conducted a tour of the physical plant accompanied by Assistant Administrator Wyleen Rivera, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 114.6 degrees F. A comfortable temperature of 78 degrees F. was maintained in the facility.



LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has one fire extinguisher that was mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance.

During the visit, LPA observed sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

CONTINUED ON 809C
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: REEFTON GUEST HOMES, INC.
FACILITY NUMBER: 306006137
VISIT DATE: 04/30/2024
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LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on January 16, 2024. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective May 5, 2023- May 5,2024.The facility is current on Community Care Licensing annual dues.

A review of four Clients (C1-C4) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification on file for Maria Rivera # 6016264735 - Expiration 05/31/2024.

No deficiencies during this inspection visit.

An exit interview was conducted with Administrator Maria Rivera, and a copy of the report was provided
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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