<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006302
Report Date: 04/26/2024
Date Signed: 04/26/2024 04:45:07 PM

Document Has Been Signed on 04/26/2024 04:45 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:TELECARE PALMVIEW HOUSEFACILITY NUMBER:
306006302
ADMINISTRATOR/
DIRECTOR:		HERRERA-GARCIA, DANIELFACILITY TYPE:
737
ADDRESS:2255 W CRESTWOOD LANETELEPHONE:
(657) 999-5356
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 4CENSUS: 0DATE:
04/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Daniel Herrera-Garcia, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA was greeted and granted entry entry by Daniel Herrera-Garcia, administrator.

An initial application for a license to operate as an Enhanced Behavioral Support Home was received by the Department on December 21, 2022 for a capacity of four clients including one non-ambulatory. LPA accompanied by administrator toured the physical plant. Facility is a one-level home with a frontyard, backyard and attached garage. There are four individual bedrooms. Each of the bedrooms include all necessary components of furnishing including a light, chair, storage space for personal items and a full-size or larger bed as well as a supply of new linen and bedsheets. An additional supply for each bed was also observed to be present in the attached garage. There are three bathrooms on the premises. Common living spaces are present and a computer connected to the internet is present for the use of the clients in care. Facility is clean, sanitary and free of odors in all areas inspected.

Kitchen equipment is present and operating as required. Utensils and plates are observed to be plastic for safety purposes. A supply of non-perishable food is already present and administrator states perishable will be provided as required by Title 22 Regulations once clients are admitted.

The centrally stored medication storage will be placed in a locked medication cart along with a lockable refrigerator for medication requiring cold storage. The garage is also used for additional storage of food and activity items, along with emergency and back-up supplies and as a meeting room. There is a locked administrative office present. Staff and client records will be maintained in the office and placed under lock as well. Staff files were not reviewed at this time as the facility is not yet receiving clients. Administrator stated that Regional Center of Orange County had however anticipated placement of several clients once the license to operate is granted. A sample client file was requested and reviewed to include all necessary components. The administrator's certificate and health screening were also requested and reviewed. CONTINUED ON FORM LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: TELECARE PALMVIEW HOUSE
FACILITY NUMBER: 306006302
VISIT DATE: 04/26/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONTINUED FROM FORM LIC809
Eight staff members have already been assigned to the location, with additional staffing to follow shortly. The baseline staffing requirements will be one lead and two staff per shift, with a potential for more supervision if placement requires. 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 in addition to an operational sprinkler system and confirmed to be functional. Sharp instruments and cleaning supplies are observed to be secured with magnetic locks throughout.

LPA and licensee toured the outside of the facility and observed it to be free of obstructions. A shaded area is present in the back of the house and is equipped with outdoor furniture for the enjoyment of clients and visitors. The perimeter gates present on both sides of the house are self-latching and 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: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2