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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006458
Report Date: 05/16/2024
Date Signed: 05/16/2024 02:14:38 PM

Document Has Been Signed on 05/16/2024 02:14 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:ADULT ENRICHMENT CENTERFACILITY NUMBER:
306006458
ADMINISTRATOR/
DIRECTOR:		KELSEY, WILLIAMFACILITY TYPE:
775
ADDRESS:1813 E DYER RD. #411TELEPHONE:
(714) 576-2688
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 121CENSUS: 120DATE:
05/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Pete Perez - Licensee, William Kelsey - Administrator, Reese Perez - AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with Licensee (Lic) Pete Perez and Administrators (ADs) William Kelsey and Reese Perez. An application to operate an Adult Day Program (ADP) for (120) capacity, (120) ambulatory, (0) non-ambulatory, and (0) bedridden clients was received by CCL on November, 13 2023.

Structure:
The facility is a two-story building, with one computer lab, two bathrooms, two activity rooms, two therapy051 rooms, six training/educational stations, a kitchen, two staff offices, and storage closets. The second floor consists of a cafe, a fitness center, skills training area, two offices and two bathrooms. There is no backyard or patio space. LPA observed the See Something, Say Something poster (PUB 475) in the facility posted on the wall in the entranceway.

Toxins:
All and any toxic chemicals, cleaning solutions, and disinfectants are inaccessible to clients and will be stored and locked in storage closets.

Medications, First-Aid Kit & Book:
Facility will not manage clients’ medication. First aid kit is stored in the staff office. The first aid kit has all the required elements.

Resident & Staff Files:
Records will be kept in a locked file cabinet.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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: ADULT ENRICHMENT CENTER
FACILITY NUMBER: 306006458
VISIT DATE: 05/16/2024
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Fire Extinguisher:
Fire extinguishers were observed to be fully charged with service tag dated April 15, 2024

Reading Material, Games, Equipment & Materials:
The facility has arts and crafts supplies, board games, puzzles, exercise equipment and other recreational materials for client use stored in various activity rooms.

Fire clearance:
Was approved by a fire inspector of Orange County Fire Authority on December 15, 2023. No special conditions noted.

Component III:
Provided at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements.

Bathrooms:
All bathrooms have working plumbing. Hot water measured between 105 and 120 degrees Fahrenheit.

Emergency Phone Numbers, Exit Plan & Menu:
Posted and available, means of exiting, and emergency phone numbers. Facility will not provide food service.

Smoke Detectors:
Smoke detectors and carbon monoxide detectors tested operational.

Appliances:
Refrigerator and microwave are operational.

The Administrators were notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted, and a copy of this report was provided at the end of the inspection.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
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