<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000622
Report Date: 09/13/2024
Date Signed: 09/13/2024 03:58:05 PM

Document Has Been Signed on 09/13/2024 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ARCENE GUEST HOME IIFACILITY NUMBER:
306000622
ADMINISTRATOR/
DIRECTOR:		MAILA ENRIQUEZFACILITY TYPE:
740
ADDRESS:508 MICHEL PLACETELEPHONE:
(714) 996-4717
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY: 6CENSUS: 3DATE:
09/13/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Malia EnriquezTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced Plan of Correction (POC) inspection. LPA was greeted and granted entry by. Administrator (AD) Malia Enriquez was contacted by phone and arrived at approximately 2:00 p.m. and LPA explained the purpose of the inspection.

Deficiencies 87412(a), 1569.69(a)(2), 87555(b)(8), 1569.605, 87303(a), 87303(f)(1), 87309(a), 87468(c)(2)(A), 1569.313, 87465(h)(5), 87463(a), 1569.695(c), and 1569.625(b)(1) were previously cited on August 6, 2024, during facility's annual/required inspection. During today’s visit, LPA verified six of thirteen POCs for citations were met.

POCs for citations 1569.605, 1569.625(b)(1), 1569.313, 1569.695(c), 87468(c)(2)(A) is being extended to close of business Monday, September 16, 2024.

Based on today’s observations, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Civil penalty for failure to correct is also being assessed. An exit interview was conducted and a copy of this report and appeal rights was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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 2
Document Has Been Signed on 09/13/2024 03:58 PM - It Cannot Be Edited


Created By: Claudia Gutierrez On 09/13/2024 at 03:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ARCENE GUEST HOME II
FACILITY NUMBER: 306000622

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2024
Section Cited
HSC
87555(b)(8)

1
2
3
4
5
6
7
All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
AD stated they will complete a thorough cleaning of the pantry and discard of any spoiled or expired food and provide proof to LPA via email by POC date.
8
9
10
11
12
13
14
Based on observation and AD interview, the licensee did not comply with the section cited above, as multiple food items cannot be accessed to verify expiration lables in the pantry, which poses an immediate health, safety and personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2