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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006179
Report Date: 09/20/2024
Date Signed: 09/20/2024 02:57:55 PM

Document Has Been Signed on 09/20/2024 02:57 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:FOOTHILL RESIDENTIAL CAREFACILITY NUMBER:
306006179
ADMINISTRATOR/
DIRECTOR:		QUEZADA, JOSHUAFACILITY TYPE:
735
ADDRESS:8404 E FOOTHILL STTELEPHONE:
(562) 756-6463
CITY:ANAHEIMSTATE: CAZIP CODE:
92808
CAPACITY: 4CENSUS: 3DATE:
09/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Joshua QuezadaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. Upon arrival, LPA knocked on the door and received no response. At 12:15 p.m. LPA placed a call to Administrator (AD) Joshua Quezada, who indicated they would be arriving shortly. AD arrived at 12:30 p.m. and granted LPA entry into the facility, and the purpose of the inspection was discussed.

During the inspection, LPA 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 three client bedrooms, two bathrooms, and attached two-car garage. There is a fourth vacate bedroom. Bedroom was recently constructed as an addition to the facility. All required documentation was submitted to the CCL regional office on September 4, 2024, and an inspection date for a new fire clearance is currently pending. All client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. Per AD, all clients were away at day program, and during the inspection, LPA observed one client arriving from day program. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 107.2-109.4 degrees Fahrenheit. LPA 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 dated April 22,2024. 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. LPA reviewed three client files and two staff files. LPA interviewed client and staff 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: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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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