306004763-5-9-2023-22-AS-LMAZ-CRNJHQ-20230509070416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004763
Report Date: 05/08/2023
Date Signed: 05/09/2023 07:05:01 AM

Document Has Been Signed on 05/09/2023 07:05 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	RYAN'S REACH R&R		FACILITY NUMBER:	306004763
ADMINISTRATOR:	CHARLES W. MICHAELIS		FACILITY TYPE:	735
ADDRESS:	1321 LEAR LANE		TELEPHONE:	(657) 457-2547
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY: 6		CENSUS: 4	DATE:	05/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Elaine Contreras		TIME COMPLETED:	05:00 PM

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Licensing Program Analysts (LPA) Lydia Martinez made an unannounced visit to conduct a Required – 1 Year inspection. Upon arrival LPA was greeted by Staff Haydee Watanabe and reason for visit was explained. There are currently 4 Clients residing at the facility. Two clients and one staff were present. Per Staff, other two clients were out in community . Administrator Elaine Contreras arrived shortly after.

LPA Martinez, along with Staff conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:
Facility is a single-story house with four bedrooms, two bathrooms, living room, dining room and an attached 2 car garage that is used for storage. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. The back yard has a patio with table and chairs to accommodate clients and visitors. Client bedrooms were observed to be spacious and easily accommodate furnishings such as lamps, chair, dresser and a bed. Bathrooms were clean, faucets, showers and toilets were operational. Hot water temperature in client bathroom was within regulatory requirements. Linen and hygiene supplies were stocked in hallway closet. Emergency Phone Numbers and Exit Plan were reviewed. Food prep area is clean and organized. Food supply meets the requirement of one (1) week supply of non-perishable and two (2) day supply of perishables. Emergency food and water supply is available. Smoke detectors are centrally wired and carbon monoxide detectors were found to be operational. Fire Extinguishers was charged. Fire Drill last conducted on 03/01/2023. Stove burners, microwave, washer, and dryer are operational. Chemicals and sharps are made inaccessible to the clients. Cleaning supplies are stored under locked sink cabinet and in locked cabinets in laundry room. Medications are centrally stored in a locked medication cabinet in dining room. Medications reviewed appear to have been dispensed accurately.

(cont LIC809c)

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: RYAN'S REACH R&R	FACILITY NUMBER: 306004763
	VISIT DATE: 05/08/2023

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First-Aid Kit had all the required elements and Activity Supplies were observed and available. There is a working land line at the facility.

LPA reviewed four client files and one staff files. LPA interviewed 1 staff. All four clients have conservators, therefore, facility does not manage client's monies. Facility is not vendorized by Regional Center of Orange County.

Indoor and outside passageways are free of obstruction.

In order to update CCL file, please provide the following updated documents to CCL by 05/19/2023: 1.) Designation of Administrative Responsibility (LIC308) 2.) Personnel Report (LIC500); 3.) Emergency Disaster Plan (LIC610D); and 4.) Administrator certificate.

Based on observations made during today's visit in the areas reviewed, no deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations. Copy of this report will be sent to email on file.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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