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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006660
Report Date: 02/19/2025
Date Signed: 02/19/2025 02:49:31 PM

Document Has Been Signed on 02/19/2025 02:49 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:HAYWARD HOME CAREFACILITY NUMBER:
306006660
ADMINISTRATOR/
DIRECTOR:
DAVIS, JOHN AFACILITY TYPE:
735
ADDRESS:924 S HAYWARD STREETTELEPHONE:
(858) 337-7676
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 4CENSUS: 0DATE:
02/19/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Demokan Oncel, Licensee and John Davis, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with Administrator (AD) John A. Davis and Licensee (LE) Demokan Oncel An application to operate a level 3 Adult Residential Facility was received by our agency on November 15, 2024 for a total capacity of four ambulatory clients.

The facility is a one story home with four client bedrooms and an additional office/staff room, two-and-a-half bathrooms, a living room, a kitchen, a dining area,and an attached two car garage. The hot water temperatures ranged from 105.2 to 105.4 degrees Fahrenheit. There is ample room in the backyard with two self-latching gates. There will be a shaded seating area and there were no obstacles or hazards in the backyard. LPA observed the See Something, Say Something poster (PUB 475), Theft and Loss Procedures, Emergency Phone Numbers and Family Council information in the entry area. All four client bedrooms had the required furnishings, linens and blankets.

LPA toured the kitchen area and observed all toxic chemicals, cleaning solutions, and disinfectants are inaccessible to clients and will be stored and locked underneath the kitchen sink. A supply of seven-day non-perishable food was observed and will be maintained on hand. AD will provide two-day perishables upon receipt of clients in care .Electric stove, dishwasher, refrigerator, microwave, washer, and dryer are new and operational.

Medications will be stored in a locked cabinet in the laundry room. The first aid kit is stored in the medication cabinet and has all the required elements. Reading materials and games were observed in the living room with a phone for client use. The fireplace had a screen. Smoke detectors and carbon monoxide detectors tested operational. The fire extinguisher is fully charged and was serviced on November 8, 2024.

LPA conducted the Component Three Orientation with AD and LE. AD and LE 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 to Licensee.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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