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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881345
Report Date: 10/17/2022
Date Signed: 10/17/2022 10:05:29 AM

Document Has Been Signed on 10/17/2022 10:05 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SOLAIRE AT ORANGE GROVE HOMES INCFACILITY NUMBER:
331881345
ADMINISTRATOR:JIMENA, MARLITAFACILITY TYPE:
735
ADDRESS:5802 ORANGE GROVE AVETELEPHONE:
(562) 569-8115
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 4CENSUS: 0DATE:
10/17/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Marlita Jimena, LicenseeTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Jesse Gardner conducted an announced pre-licensing inspection to the facility to complete the pre-licensing inspection and Comp III. LPA arrived at the facility at 08:38 PM and was met with Licensee Jimena. Jimena accompanied LPA on a tour of the inside and outside of the facility.

Currently there are no residents in care. The facility is a four bedroom, three bathroom home. The facility has a living room, dining room/kitchen, and staff area. Per the approved fire clearance, the licensee is approved for 4 ambulatory residents. All bedrooms are furnished with bed, night stand, dressers and have adequate lighting for residents use. The facility currently has linens, towels and a sufficient amount of hygiene products for residents. The water temperature was tested and measured between 104.4 to 106.8 degrees Fahrenheit. The smoke alarms and carbon monoxide alarm were tested and are in operating order. LPA observed one fully charged fire extinguisher which was present in the kitchen area. The kitchen was observed to have dishes, silverware and pots and pans. The knives were stored in a locked pantry in the kitchen. The medications, will be stored in a locked closet in the hallway. The chemicals are stored in the locked garage.

The backyard was observed to be fully fenced with an unlocked gate and plenty of shade via a shade cover over a backyard concrete slab with furniture.

LPA found all facility features to be in compliance and in line with Title 22 Regulations.

An exit interview was conducted and a copy of this report was reviewed with and provided to Licensee Jimena.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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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