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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006189
Report Date: 01/19/2023
Date Signed: 01/19/2023 04:23:29 PM


Document Has Been Signed on 01/19/2023 04:23 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:KAEGO'S RICHMAN GARDENSFACILITY NUMBER:
306006189
ADMINISTRATOR:HARVEY, LUPEFACILITY TYPE:
740
ADDRESS:317 N. RICHMAN GARDENSTELEPHONE:
(213) 478-0460
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:26CENSUS: 17DATE:
01/19/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Lupe HarveyTIME COMPLETED:
04:35 PM
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This unannounced Plan of Corrections inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of verifying correction of deficiencies issued during the post licensing inspection conducted on 12/13/22. LPA met with Administrator (AD) Lupe Harvey and discussed the purpose of the inspection.

Type B Violation cited under Health and Safety Code section 1569.625(b)(2) pertaining to staff training has been CLEARED. The plan of correction stated that “Licensee stated they will document training for all staff, provide any missing training, and provide proof to LPA by POC due date.” LPA had provided an extension of the due date to 01/14/23. On 01/12/23, LPA received via email documentation of training for 12 staff.

Type B Violation cited under Title 22 Regulation 87506(b)(15) pertaining to resident files has been CLEARED. The plan of corrections stated that “Licensee stated they will gather all appraisals, conduct additional appraisals as necessary, and provide proof to LPA by POC due date.” LPA had provided an extension of the due date to 01/14/23. On 01/12/23, LPA received via email documentation of recent appraisals for 16 residents.

An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023
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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