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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530188
Report Date: 05/23/2024
Date Signed: 05/23/2024 03:02:31 PM

Document Has Been Signed on 05/23/2024 03:02 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:ESPERANZA'S PLACE IIFACILITY NUMBER:
365530188
ADMINISTRATOR/
DIRECTOR:		AGUILAR, DANETTEFACILITY TYPE:
735
ADDRESS:919 W LOCUSTTELEPHONE:
(714) 483-8057
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 4CENSUS: 0DATE:
05/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Applicant/Administrator Danette Aguilar and Applicant Erik AguilarTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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On 05/23/2024 at 12:45 PM, Licensing Program Analyst (LPA) Melody Brown conducted an announced visit to the facility for purpose of Prelicensing evaluation. LPA met with Applicant/Administrator Danette Aguilar and Applicant Erik Aguilar. An initial application to operate an Adult Residential Facility (ARF) was submitted to the Central Applications Bureau (CAB) on 02/20/2024 for a total capacity of four (4) Ambulatory clients. Fire clearance was granted on 12/14/2023. LPA Brown observed the following:
Structure:
Facility was a one (1) story house with four (4) client bedrooms, and two (2) bathrooms, living room, dining area, and kitchen. There was an attached two (2) car garage in the right side of the house.

Heating/Cooling System:
Central heating and air conditioning system installed with one (1) central panel located in the hallway to
control entire house.

Bedrooms:
Each client bedrooms accommodate any ambulatory client. All client bedrooms were adequately furnished
with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm.

Bathrooms:
The (2) two client/staff bathrooms have a working toilet, wash basin, and shower with an adequate supply of
toilet paper and soap. LPA Brown tested the water temperatures in the clients' bathrooms. LPA Brown verified water temperature was measured at 110 degrees Fahrenheit.
***CONTINUED ON LIC 809-C***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: ESPERANZA'S PLACE II
FACILITY NUMBER: 365530188
VISIT DATE: 05/23/2024
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***CONTINUED FROM LIC 809***
Kitchen/Laundry:
An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments
were secured in a locked cabinet under the kitchen sink. There was adequate room for food storage. LPA
Brown observed the stove to be operational. Refrigerator/freezer were in working condition. There is sufficient
storage for perishable food. There was adequate seating for meals for all clients. Laundry area with washer
and dryer was in the garage. Laundry detergents are locked in the garage and cleaning supplies were observed locked under the sink. Clients can access the garage..

Living/Family room:
There was a living/family room with adequate seating for all clients and a working TV.

Linens and Hygiene Supplies:
An adequate supply of linens was stored in each client room.

Yards/Outside:
Patio furniture for outdoor seating observed. Self-latching handle gate on left and right side of the house that leads into the backyard. Pool was locked with the required fence was observed. All outdoor pathways were free of obstructions.

Emergency Phone Numbers, and Exit Plan:
Facility sketch was observed posted near the main entrance. There was Let-Us-No poster observed, Personal Rights and Emergency Disaster Plan posted in a common area.

General items:
One (1) fire extinguisher was charged and located in the kitchen. Six (6) smoke detectors and one (1) carbon
monoxide detector were tested and were observed to be in working order. Client records and staff records will
be stored in a locked cabinet in the hallway. First Aid kit with required components, and locked area for
medication storage was observed. LPA Brown observed a facility phone and was operational as evidenced by
LPA dialing the number. ***CONTINUED ON LIC 809-C***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: ESPERANZA'S PLACE II
FACILITY NUMBER: 365530188
VISIT DATE: 05/23/2024
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The phone number designated for the facility is 909-391-7182. There is enough
Emergency water supply and 72-hour Emergency bag pack for clients observed and the required 72-hour
emergency food supply for clients and staffs available at the facility. Component III was completed on this day
as well.

Additionally, LPA Brown observed the facility having Visitor Sign In/Sign Out Sheet and Client Sign In/Sign
Out Sheet, upon entering facility. LPA Brown observed COVID signages throughout the facility, disposable
towels in bathrooms for washing hands.

No needed corrections were observed at time of visit. The LPA will inform the Centralized Applications Bureau (CAB) that the home is ready for licensure. An exit interview was conducted, and a copy of this report, LIC809 was discussed and provided to Applicant/Administrator Danette Aguilar and Applicant Erik Aguilar.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC809 (FAS) - (06/04)
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