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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006278
Report Date: 03/07/2024
Date Signed: 03/07/2024 10:36:28 AM

Document Has Been Signed on 03/07/2024 10:36 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:AFESTIN HOMES IIIFACILITY NUMBER:
306006278
ADMINISTRATOR:FESTIN, ALIZAFACILITY TYPE:
735
ADDRESS:2904 W. LYNROSE DRTELEPHONE:
(714) 325-0824
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 4CENSUS: DATE:
03/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:TIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr arrived at the facility unannounced for the purpose of
conducting a required annual inspection. LPA was greeted and granted entry into facility by Direct Care Staff Rosa Rojo. Administrator Aliza Festin joined the inspection approximately 30 minutes after LPA's arrival.

The facility is a one-story home with four client bedrooms, three bathrooms, kitchen, dining room, living room, backyard and attached 2-car garage. Facility appears clean, safe and sanitary. LPA noted two clients were away at day program. All rooms had the required elements including bed, chair, closet space and ample lighting. Facility has extra linens for clients in the hallway closet. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water in the common bathroom measured at 105.8 degrees Fahrenheit. The hot water in the private bathroom closest to the common bathroom measured at 105 degrees Fahrenheit. Hot water in the private bathroom closest to the garage measured at 106 degrees Fahrenheit. LPA issued a Technical Assistance advising the facility maintain a water log since the temperatures are close to the threshold. LPA observed facility has emergency food and water supply. LPA observed the fire extinguisher is fully charged as indicated by the arrow pointing to the green zone on the meter. There is also a receipt taped to the extinguisher indicating it was purchased on 2/15/24. LPA observed knives to be locked up in the kitchen. Toxins and chemicals are locked up in a cabinet in the garage. Medication for each client is kept locked in a cabinet near the dining room. The backyard has a shaded seating area. LPA reviewed three staff files, all four client files, all four client medication and three client P&I. The fourth client manages their own money. LPA interviewed two clients and one staff member. LPA issued two additional technical assistances to advise the facility maintain drill logs for at least a year and to use the same organization system in all client files.

Based on today's inspection, no deficiencies were noted. An exit interview was conducted an a copy of this report was provided.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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