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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006217
Report Date: 08/30/2024
Date Signed: 08/30/2024 10:45:44 AM

Document Has Been Signed on 08/30/2024 10:45 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:ADLER HEALTHFACILITY NUMBER:
306006217
ADMINISTRATOR/
DIRECTOR:		MCPHAIL, ANDREFACILITY TYPE:
772
ADDRESS:275 E. WILSONTELEPHONE:
(310) 909-3400
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 6CENSUS: 0DATE:
08/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:Andre McPhail-Administrator, Maria Ongkingo-Program DirectorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Samer Haddadin conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Administrator (AD) Andre McPhail.

For today’s visit, LPA observed zero clients in care.

LPA Ramirez toured the interior and exterior portions of the facility with AD McPhail. The facility is a single story structure and is licensed for six ambulatory clients. There are a total of three bedrooms. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detectors were tested and operational. There are a total of two restrooms. Restrooms were observed to be in good repair, to have a supply of soap, toilet paper and paper towels. LPA reminded AD to have hand washing signs posted in both restrooms. Water temperature tested between 112.6-113.0 degrees.

Sharp items and knives were locked and inaccessible to clients in care. Fire extinguisher was charged, and located by the kitchen.

LPA Ramirez observed the emergency disaster and evacuation plan which is located to the left of the entryway. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to clients in care.

CONTINUED ON LIC809-C...

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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: ADLER HEALTH
FACILITY NUMBER: 306006217
VISIT DATE: 08/30/2024
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For the exterior portion, LPA Ramirez observed a shaded patio area with furniture, and the grounds were free of any hazards. There are two gates in the backyard, which are self-closing and self-latching. No bodies of water were observed.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with facility representative.

A copy of this report was provided at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
LIC809 (FAS) - (06/04)
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