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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006215
Report Date: 11/13/2024
Date Signed: 11/13/2024 11:06:04 AM

Document Has Been Signed on 11/13/2024 11:06 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SWEET LIFE FAMILY HOME CAREFACILITY NUMBER:
306006215
ADMINISTRATOR/
DIRECTOR:
LAINI POLINGFACILITY TYPE:
735
ADDRESS:38 GOLDEN STARTELEPHONE:
(949) 235-4752
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 4CENSUS: 4DATE:
11/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Laini Poling, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Laini Poling, Administrator at 8:30 AM.

The facility is a level 2 two story building with six bedrooms and , one client bathroom and two private bathrooms for staff with an approved fire clearance for four ambulatory. The facility currently has a census of four clients in care. All four clients were at work or Adult Day Program (ADP) and were not at facility at time of visit.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, and testing hot water temperature in one client bathroom. The hot water temperature measured 120.0 degrees Fahrenheit and all smoke detectors were operational. LPA observed multiple shaded seating areas outdoors, with one exterior gate and there is a locked above ground covered spa in the backyard. All client bedrooms had the required furnishings and clean linens. LPA toured the upstairs which is gated off and where family reside. All clients reside downstairs. Administrator has an evacuation chair upstairs.

The fire extinguisher is charged and was serviced on August 26, 2024. The facility’s last fire drill was conducted on September 29, 2024 and an earthquake drill on October 12, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. All sharps and toxic chemicals were locked underneath the kitchen sink. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid Kit has the required elements and a First Aid Manual book.

(Continued on LIC 809)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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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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: SWEET LIFE FAMILY HOME CARE
FACILITY NUMBER: 306006215
VISIT DATE: 11/13/2024
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(Continued from LIC 809-C)

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of client records. Client P&I records were reviewed and were accurate. Facility files have Admissions Agreements that comply with Title 17 and Title 22. LPA interviewed staff present regarding care provided. LPA confirmed that administrator has a pending renewal administrator certificate which will expire on February 21, 2026.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Laini Poling, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC809 (FAS) - (06/04)
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