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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006475
Report Date: 06/12/2024
Date Signed: 06/12/2024 09:13:38 AM


Document Has Been Signed on 06/12/2024 09:13 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:LOVING CARE OF THE HUNTINGTON BEACHFACILITY NUMBER:
306006475
ADMINISTRATOR:KANASE, VIJAYFACILITY TYPE:
740
ADDRESS:8271 KINER DRIVETELEPHONE:
(562) 234-7657
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY:6CENSUS: 6DATE:
06/12/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Licensee Vijay KanaseTIME COMPLETED:
09:25 AM
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Licensing Program Analyst (LPA) Jenifer Tirre made an announced inspection visit to follow up on corrections identified during Pre Licensing visit on 05/30/2024. LPA identified themselves and discussed the purpose of the visit with Licensee/ Administrator Vijay Kanase . An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 4/29/2024. Facility is a change of ownership with six residents in care during today's visit. LPA observed the following:

At 8:39 AM LPA toured the facility and observed the following:

· Garage door has secure locked door knob upon entrance
· Facility has proper approved First Aid Handbook
· Facility has secured gates on both sides of house that have audible alarms and are self latching
· Plumbing drain to outside passageway has been repaired, capped and no over flow observed
· Resident Room 3 has repaired wall
  • Water temperature was retested at 119 degrees F


Noted items from visit on 05/30/2024 have been addressed. The facility is ready to be licensed.


Exit interview conducted with Licensee and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
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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