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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006490
Report Date: 09/16/2024
Date Signed: 09/16/2024 01:28:29 PM

Document Has Been Signed on 09/16/2024 01:28 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:KENDOR BOARD AND CARE HOMEFACILITY NUMBER:
306006490
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, ARIANNAFACILITY TYPE:
735
ADDRESS:8640 KENDOR DRIVETELEPHONE:
(714) 723-0135
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 0DATE:
09/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Arianna Hernandez & Diana HernandezTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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Licensing Program Analysts (LPAs) Jerome Haley made an announced visit for the purpose of conducting a pre-licensing evaluation. LPA Haley was greeted and granted entry by applicants Diana and Arianna Hernandez.

An initial application to operate an Adult Residential Care Facility, with a capacity of 6 ambulatory clients was submitted to the department for licensure.


Fire clearance: Orange County Fire Authority granted the Fire Clearance April 3, 2024

Structure:
The facility is a single level structure, with an attached garage. There’s a total of 5 bedrooms, 3 of will be for clients. There’s one living room space, one dining room, and one office area. Bedrooms (Clients): All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. All grab bars were tightly secured. Hot Water Temperature in Bathroom #1 was measured at 119 degrees Fahrenheit and 105.9 degrees Fahrenheit in bathroom #2. Kitchen: The gas stove was operational, and all 4 burners were in good working order. Knives and sharp objects are locked in the medication closet near the front door. Food Service: A food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the pantry, and a sample menu was observed on the side of the refrigerator. Garage: There's an extra refrigerator used to store an additional food supply. A large supply of non-perishable food items was observed in the garage. Hazardous cleaning chemicals and a supply of hygiene items are stored in the garage. An emergency supply of food items and emergency supply of water was observed. Laundry: There's a laundry area equipped with a washer and dryer. No laundry detergents or any other chemicals are kept in the laundry area.

Continued on LIC809C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
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: KENDOR BOARD AND CARE HOME
FACILITY NUMBER: 306006490
VISIT DATE: 09/16/2024
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Client & Staff Files: Client and staff files are stored in the office area that's currently in the dining room. The office area will be relocated to a room, once the room is vacated.

Medications/First-Aid Kit: Medication and first aid kits are stored in the locked medication closet near the front door. The first aid kits have all the required items.

Linens & Hygiene Supplies: Adequate supply of linen was stored in a cabinet in the hallway. An additional supply of hygiene supplies are stored in the garage. Daily Hygiene items are kept in the client bedrooms. Toxins: All toxic chemicals, cleaning solutions, laundry detergents and disinfectants are inaccessible to clients and are stored in the locked garage.

Backyard/Exterior:
There is a large backyard with large exit gate. A shaded patio area with a table and chairs was observed. All walkways were clear and free of obstruction. There’s a shed in the backyard used to store miscellaneous items.
Bodies of Water: No bodies of water were observed.

Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Two carbon monoxide detectors were observed mounted on the walls in the facility.

Emergency Phone Numbers, House Rules, Exit Plan & Menu:
Posted & readily available for review an emergency disaster plan, a list of emergency phone numbers, house rules on the facility postings board in the office are, and a sample menu posted in the kitchen.

Fire Extinguisher: Observed full charged mounted in the kitchen and in the office area on the desk.

Component III: Will be waived as the facility is currently licensed.

No corrections are needed. No deficiencies were observed. The facility is ready for licensure.
An exit interview was conducted, and a copy of this report was provided to applicants Dianna and Arianna Hernandez.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC809 (FAS) - (06/04)
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