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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000560
Report Date: 07/14/2021
Date Signed: 07/14/2021 11:05:06 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GARDEN VILLAFACILITY NUMBER:
306000560
ADMINISTRATOR:MARILES BORJAFACILITY TYPE:
735
ADDRESS:13031-13061 WILSON STREETTELEPHONE:
(714) 537-1545
CITY:GARDEN GROVESTATE: CAZIP CODE:
92844
CAPACITY:32CENSUS: 31DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mara GadonTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required inspection visit. LPA was greeted at the door by receptionist and granted entry. LPA met with Mara Gadon, receptionist and explained the nature of the visit. Mariles Borja, Administrator arrived at a later time.

LPA accompanied by receptionist began the tour of the facility. The facility currently has 31 clients in care. LPA observed clients through out the facility relaxing. All clients appeared happy and well taken care of. Facility appears clean and sanitary. Facility staff screens all visitors to the facility and keeps a log as well. LPA observed the screening station along with temperature sign in logs in the main entry of facility. Facility keeps documentation in regard to covid for all the visitors, staff, and clients. LPA observed medication to be locked and inaccessible to clients in care. Each house has a medication cart along with first aid kits and PPE supplies. LPA observed facility has covid precautionary posting throughout the facility as well as all required department postings. Facility has an active covid-19 prevention plan in place for the safety of clients in care. LPA observed ample of emergency food and water. Facility has PPE, incontinence, and cleaning supplies. Facility has sanitation precaution in place through out the facility and all common spaces. LPA toured the outside and observed there are seating areas through out area. Visitation are done through out the facility and outside as well. Facility has a plan for covid testing clients and staff as needed as well as a plan for isolation as needed.

Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrator and a copy of this report was provided and left at facility.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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