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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006318
Report Date: 02/05/2025
Date Signed: 02/05/2025 04:24:14 PM

Document Has Been Signed on 02/05/2025 04:24 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:AFESTIN HOMES GRAYSONFACILITY NUMBER:
306006318
ADMINISTRATOR/
DIRECTOR:		FESTIN, ALEXANDERFACILITY TYPE:
735
ADDRESS:953 S SALEM STTELEPHONE:
(714) 325-0824
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 4CENSUS: 4DATE:
02/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:12 PM
MET WITH:John Domingo TIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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On February 5th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual visit. Upon arrival LPA Vanegas was greeted and granted entry by assistant administrator (AA) John Domingo and explained the purpose of the visit. LPA Vanegas set up equipment and began a tour of the facility and observed the following.

This is a one storied home with four bedrooms and two bathrooms all which are client bedrooms and bathrooms and a detached two car garage. LPA Vanegas observed the kitchen area to be clean and free of debris and mildew. LPA Vanegas observed a microwave, gas stove, dishwasher, and refrigerator that were all tested to be operational and in good repair. LPA Vanegas observed there to be a two day supply of perishable food and a seven day supply of non-perishable food.

LPA Vanegas observed client bathrooms to be clean and free of debris and mildew. Toilet and water faucets tested to be operational and in good repair. Client bathrooms contained all required furnishings such as grab bars, shower chair, and slip resistant matts. Water tested between 115.4 and 115.6. LPA Vanegas observed fire extinguisher to be fully charged and up to date. LPA Vanegas observed smoke and carbon monoxide detectors to be operational and in good repair.

LPA Vanegas observed client rooms to consist of all required furniture such as a chair, lamp, chest drawers, a bed, and linens in good repair meaning no strains or tears. Rooms are large enough for clients to move freely around the room and doors are not obstructed by objects. LPA Vanegas observed garage to be clean and in good repair. LPA Vanegas observed the outside of the facility to have a shaded sitting area and for the backyard to be clean and free of any obstructions along emergency exit route. Side doors are unlocked and self latching.
CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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: AFESTIN HOMES GRAYSON
FACILITY NUMBER: 306006318
VISIT DATE: 02/05/2025
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LPA Vanegas observed medications, sharps and toxins to be locked away and inaccessible to clients in care. LPA Vanegas reviewed medications with Administrator (AD) Aliza Festin. Medications are being documented when administered. Per LPA Vanegas review medications are being administered per physicians orders.

LPA Vanegas reviewed infection control plan, and disaster preparedness plan and all components of documents were filled out and up to date. LPA Vanegas reviewed first aid kit and it consisted of all required items such as scissors, tweezers, adhesive tape, bandages, and a thermometer. LPA Vanegas reviewed P&I with Administrator (AD) Aliza Festin. All balances were observed to be accurate and accounted for.

LPA Vanegas reviewed five staff files and four client files. All files (Staff and resident) consisted of the correct documentation and all mandatory staff training was completed. Based on observations made during today's visit no citations will be cited per title 22 chapter 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC809 (FAS) - (06/04)
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