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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006519
Report Date: 05/03/2024
Date Signed: 05/03/2024 04:14:12 PM


Document Has Been Signed on 05/03/2024 04:14 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:B&C SENIOR LIVINGFACILITY NUMBER:
306006519
ADMINISTRATOR:EUGENIO, JOHN JASONFACILITY TYPE:
740
ADDRESS:1354 N FERNDALE ST.TELEPHONE:
(714) 488-8413
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:6CENSUS: 0DATE:
05/03/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Brian Estorba
John Jason Eugenio		TIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Jerome Haley made an announced visit to conduct the second pre-licensing inspection. LPA Haley was greeted and granted entry by Applicant Brian Estorba. LPA Haley explained the reason for the visit upon entry.

During a tour of the facility, LPA Haley observed that the following items have been corrected:

1) A new fire extinguisher was purchased from Home Depot and mounted on the wall next to the kitchen 2) All backyard clutter (bricks, pipes, and other items) have been removed, 3) All planks of wood have been removed from behind the garage 4) Exposed wires of the sprinkler system have been covered 5) Outdoor security lighting has light bulbs 6) staff bathroom toilet overflow and leaks have been repaired 7) Both showers now have non-slip mats 8) Grab bars have been installed in both bathrooms, 9) the wires from Satellite dish have been properly secured and are no longer hanging from the roof 10) Both backyard exit gates are now self-latching and self-closing. 11) Hot water in both bathrooms have been adjusted and meet regulation requirements. Hot water temperature measured at 117.3 degrees Fahrenheit in bathroom #1 and 117.8 degrees Fahrenheit in bathroom #2.


All items have been corrected. No new deficiencies were observed. The facility is ready for licensure.

Component III was waived as the applicant operates a licensed facility.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024
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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