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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603092
Report Date: 06/27/2024
Date Signed: 06/27/2024 03:58:22 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/27/2024 03:58 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:WHITE ORCHID GUEST HOMEFACILITY NUMBER:
374603092
ADMINISTRATOR:ESTEPA, STANFACILITY TYPE:
740
ADDRESS:978 WEST 2ND AVETELEPHONE:
(760) 737-6030
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:5CENSUS: 5DATE:
06/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator, Stan EstepaTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Administrator, Stan Estepa who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (5) residents present.

The facility is a one story home with (5) bedrooms and (2) bathrooms with attached garage. No pools or firearms are being kept at the facility.

The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to residents. The carbon monoxide was operational, and the hot water temperature 117.8F. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required food supply. LPA reviewed (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Two (2) client files were reviewed, and possessed all required paperwork. All client medication was locked in closet. LPA reviewed documentation showing the facility's last fire drill 3/3/2024, which met the department requirements. LPA observed all facility exits were clear from obstructions. An exit interview was conducted where this report was reviewed and provided.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
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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