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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006192
Report Date: 10/24/2022
Date Signed: 10/24/2022 11:52:29 AM

Document Has Been Signed on 10/24/2022 11:52 AM - 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:VIOLA HOMES ESTATEFACILITY NUMBER:
306006192
ADMINISTRATOR:MONTES, GAZEL MICHELLEFACILITY TYPE:
735
ADDRESS:15770 AZALEA WAYTELEPHONE:
(323) 304-4620
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 4CENSUS: 0DATE:
10/24/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Miatta Snetter, licenseeTIME COMPLETED:
12:15 PM
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On 10/24/2022 , Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility to conduct a pre-licensing inspection. LPA was greeted and granted entry by licensee Miatta Snetter after explaining the purpose of the visit.

An initial application for a license to operate as an Adult Resident Facility was received by the Department on 05/24/2022 for a capacity of 4 ambulatory clients. LPA accompanied by licensee toured the physical plant. Facility is a one-level home with a frontyard and attached garage. There are four individual bedrooms. Two of the bedrooms include all necessary components of furnishing including a reading light, a chair, ample storage space for personal items and a queen-size bed as well as a supply of new linen and bedsheets. The other two bedrooms are not yet furnished as client's current furniture arrangement will be transferred upon move-in. The shared bathroom is equipped with slip mats. Facility is clean, sanitary and free of odors in all areas inspected.

Licensee is seeking to license this facility to relocate the clients currently residing at another facility located in La Habra (license #306005938), after the families of the individuals in care repeatedly inquired about relocating their family members closer to them. Items such as the centrally stored medication storage will be transferred from the previous facility once licensed. Licensee was able to provide documentation and a photograph of the current secure storage to LPA during the visit.

All staff members will transition from the previous facility and have been verified to be cleared and associated in Guardian. The required Department postings will be re-utilized from the currently occupied facility. A photograph of the documents on display there was provided by the licensee during the visit.
The fire extinguisher present is mounted and charged. The fire clearance has been obtained and provided to the Department before the pre-licensing visit. Wired smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional.
CONTINUED ON FORM LIC809-C
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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: VIOLA HOMES ESTATE
FACILITY NUMBER: 306006192
VISIT DATE: 10/24/2022
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CONTINUED FROM FORM LIC809

The secure storage of sharp instruments and cleaning supplies will also be transferred from the previous facility when licensed. Licensee stated that the supply of food and water will be transferred from the current facility when licensed as well.

LPA and licensee toured the outside of the facility and observed it to be free of obstructions. A shaded area is present in front of the house and will be equipped with outdoor furniture for the enjoyment of clients and visitors. The perimeter gate present in the side yard can easily be opened in an evacuation. There are no bodies of water on the premises.

No items of non-compliance were identified during today's visit. Component III was waived. This report was reviewed with facility representative and a copy of this report was emailed to the licensee before the conclusion of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC809 (FAS) - (06/04)
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