306006361-10-5-2023-22-AS-DLMN-CWBSG8-20231005135128

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006361
Report Date: 10/04/2023
Date Signed: 10/05/2023 01:51:43 PM

Document Has Been Signed on 10/05/2023 01:51 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	VOCATIONAL INNOVATIONS GARDEN GROVE		FACILITY NUMBER:	306006361
ADMINISTRATOR:	FRANCO, AMED		FACILITY TYPE:	775
ADDRESS:	9776 KATELLA		TELEPHONE:	(714) 771-8300
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY: 90		CENSUS: 0	DATE:	10/04/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Amed Franco - Administrator		TIME COMPLETED:	10:20 AM

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) Dwayne Mason Jr. made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA arrived at the facility at 8:35 am and was greeted and granted entry by designated Administrator (AD) Amed Franco and Executive Assistant (EA) Julian Hernandez. An application to operate an Adult Day Program (ADP) for (90) capacity, (60) ambulatory, (30) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 5/22/23. Structure: The facility is a one-story building with four activity rooms, three bathrooms, four offices, lobby, file room, conference room, computer room, vocation room, two relaxation rooms, changing room, storage room, pantry and break room, and electrical room. There are two walkways on either side of the facility and a central walkway in the center of the property. The central walkway serves as the sole emergency exit. LPA did not observe any obstacles or hazards in any of the walkways. Signal System: The facility utilizes a signal system. There are seven signal buttons located in different rooms in the facility. The monitor for the system is located near a desk in Activity Room 2. The signal system emits a sound and announces a different number associated with each room in which there are signal buttons. Toxins: LPA observed chemicals, cleaning solutions, and disinfectants are inaccessible to client and will be stored and locked in the storage room and janitor closet. Medications, First aid and Files: Medication and First Aid Kit will be stored and locked in the file room. Each client’s medication will be locked in a dedicated locker in the File Room. The first aid kit has all the required elements. Client and Staff Files are kept in the file room. Fire Extinguisher: LPA observed six fire extinguisher to be fully charged as indicated by the arrow pointing in the green zone. LPA observed the service tag on each indicating they were last serviced on 8/4/23.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VOCATIONAL INNOVATIONS GARDEN GROVE	FACILITY NUMBER: 306006361
	VISIT DATE: 10/04/2023

NARRATIVE

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Activity Materials: The facility has books and games in Activity room 2. The facility also plans to bring in third party vendors/companies to lead activities for client participation.

Fire clearance: Was approved by a fire inspector of Orange County Fire Authority on 8/23/23.

Bathrooms: The bathrooms have working plumbing. Hot water measured at 107.2 degrees Fahrenheit in the east gender neutral bathroom, 109.5 degrees Fahrenheit in the east men’s restroom and 109.2 degrees Fahrenheit in the east women’s bathroom.

Component III: Provided AD with Component III presentation. Guidance provided regarding how to remain in compliance

Emergency Phone Numbers, Exit Plan & Menu: Posted and available for review

Smoke Detectors: Smoke detectors were observed to be both individual smoke detectors and dual Smoke & Carbon Monoxide detectors that are stationed throughout the facility. All detectors were tested and observed to be operational.

Appliances: Refrigerator and two microwaves tested operational

The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

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