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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006550
Report Date: 09/13/2024
Date Signed: 09/13/2024 11:42:34 AM

Document Has Been Signed on 09/13/2024 11:42 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:WESTFIELD HOMECARE LLCFACILITY NUMBER:
306006550
ADMINISTRATOR/
DIRECTOR:		SAGALONGOS, SANDROFACILITY TYPE:
735
ADDRESS:5510 WESTFIELD STTELEPHONE:
(714) 225-5818
CITY:YORBA LINDASTATE: CAZIP CODE:
92887
CAPACITY: 4CENSUS: 0DATE:
09/13/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Sandro SagalongosTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Licensee/Administrators (LE/ADs) Sandro Sagalongos and Marlene Sagalongos.

An application to operate an Adult Residential Facility (ARF) was received by our agency on April 17, 2024 for a total capacity of four ambulatory clients. Fire clearance was approved by a fire inspector from the Orange County Fire Authority on May 13, 2024.

The facility is a one-story home with four client bedrooms, two bathrooms, a living room, a kitchen, a dining area, and a detached two car garage. All exiting doors had alarm notifications. There are two backyard exit gates on each side of the house that are self-latching and unlocked. There is a shaded seating area for clients and LPA did not observe any obstacles or hazards in the backyard. There is exercise equipment for use and outdoor games to play in the backyard area. The backyard is surrounded by several various plants, flowers and a lemon tree.

LPA observed Administrator certificate, See Something, Say Something poster (PUB 475), Personal Rights, Facility sketch and Emergency Disaster Plan in the facility mounted on the wall by the dining room area near the front entry way.

Client bedrooms had the required furnishings. LPA observed all beds had linens and blankets. Smoke detectors and carbon monoxide detectors tested operational. Hot water temperatures in the bathrooms measured at 109.4 F degrees. There is a locked storage closet in the hallway that contains extra linens and blankets and toxins and laundry detergents are stored securely. All additional toxic chemicals, cleaning solutions, and disinfectants are inaccessible to clients and will be stored and locked underneath kitchen sinks in the dining room area and kitchen.

Continuation of Pre-licensing on LIC 809-C
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WESTFIELD HOMECARE LLC
FACILITY NUMBER: 306006550
VISIT DATE: 09/13/2024
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Medications will be stored in a locked closet in the dining room area. The first aid kit is also stored in the locked closet in the dining room area and has all the required elements. Staff and client records will also be stored in the locked closet in the dining area.Reading materials and games were observed in the dining room and living room. A phone is located in the dining room for clients to use.

A supply of two day/seven-day of perishable and non-perishable food was observed. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. Emergency food and water and additional supplies were observed to be well stocked in the kitchen pantry. There is a computer station for clients in the kitchen. The fire extinguisher is in the kitchen and is fully charged and serviced in May 5, 2025.

The facility is ready to be licensed. LPA conducted the Component Three Orientation with LE and AD. Licensee was 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 to the Licensee.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC809 (FAS) - (06/04)
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