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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006410
Report Date: 10/18/2024
Date Signed: 10/18/2024 10:10:24 AM

Document Has Been Signed on 10/18/2024 10:10 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:UNIQUE CARE 1FACILITY NUMBER:
306006410
ADMINISTRATOR/
DIRECTOR:		NASSIF, JOSEPHFACILITY TYPE:
735
ADDRESS:127 W BORROMEO AVETELEPHONE:
(714) 646-9820
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY: 6CENSUS: 6DATE:
10/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Joseph NassifTIME VISIT/
INSPECTION 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 Analysts (LPAs) Samer Haddadin and Claudia Gutierrez conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs were greeted and granted entry into the facility by Administrator (AD) Joseph Nassif. The facility is licensed for 6 ambulatory clients. Currently there are 6 clients living in the facility and five out of six were in day program with one client in room during today's visit.

LPAs reviewed three clients’ files and two staff files. Client files and staff files contained all required documentation. Administrator certificate expires on June 15, 2026.

LPAs along with AD toured the facility. LPAs toured the physical plant, checked food service, and the first aid kit. The facility is a one-story home with six client bedrooms, one staff room, and two clients’ bathrooms and one staff restroom.

The facility has a kitchen, dining room, and living room with an attached garage. LPAs observed smoke detectors/carbon monoxide in common areas and bedrooms; all were tested and were operational. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each client comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew.

Water temperature measured in first restroom at 107.2 and 108.8 F degrees in the second restroom. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected and LPAs observed the facility had a two-day supply of perishables and a seven-day supply of non-perishable food was available as required by regulations. (CONTINUE LIC809-C)

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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: UNIQUE CARE 1
FACILITY NUMBER: 306006410
VISIT DATE: 10/18/2024
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
LPA observed sharps and knives locked in a kitchen cabinet. LPA also observed toxin substances secured and locked and were inaccessible to clients in a storage closet in the garage.

LPAs interviewed one client and one staff.

Fire extinguisher was fully charged with last inspected on May 28th,2024. The facility’s last fire drill was conducted on October 4th,2024 and AD conducts drills monthly. Kitchen appliances are operational during today's visit. LPAs toured the backyard and observed there is a shaded seating area and in-ground pool. The pool is fully gated with self-latching gate and is secure.

No deficiencies were noted during today's inspection visit. An exit interview was conducted, and a copy of this report was provided to the administrator, Joseph Nassif

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2