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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006354
Report Date: 10/30/2024
Date Signed: 10/30/2024 04:13:34 PM

Document Has Been Signed on 10/30/2024 04:13 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:ST JOSEPH CARE VILLAFACILITY NUMBER:
306006354
ADMINISTRATOR/
DIRECTOR:		ALIPIO, DIVINA JOY M.FACILITY TYPE:
735
ADDRESS:6062 CERULEAN AVETELEPHONE:
(657) 352-8841
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY: 4CENSUS: 3DATE:
10/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Divina AlipioTIME VISIT/
INSPECTION COMPLETED:
04:25 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
Licensing Program Analyst (LPA) William Vanegas and Kimberly Lyman made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA Vanegas was greeted and granted entry by Individual Sarsi De Venecia. LPA Vanegas met with Administrator (AD) Divina Alipio and explained the purpose of the inspection.

LPAs reviewed LIC 500 for facility and were able to locate clearance for all present staff. During the inspection, LPAs and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:

This is a one-story home with five bedrooms one bedroom is used for storage and four are client bedrooms, three bathrooms, one common bathroom, one staff bathroom, and one private bathroom, and one attached two-car garage. All client bedrooms had the required furnishings. LPAs observed all client beds had linens and blankets. LPAs observed all windows were screened. The backyard has a shaded sitting area. LPA observed one client watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 114.8-117.1 degrees Fahrenheit.

Continued on LIC809C dated 10/30/2024

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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: ST JOSEPH CARE VILLA
FACILITY NUMBER: 306006354
VISIT DATE: 10/30/2024
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
LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Electric stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to clients. Medication cabinet was observed to be locked and inaccessible to clients.

LPAs reviewed three resident files, and three staff files. All resident and staff files were observed to have all required and up to date documentation. LPAs interviewed two staff members and zero clients due to unavailability.

LPAs reviewed medication administration and storage. Medications are stored in a locked cabinet. Medications are being administered as physicians order.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 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: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2