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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000629
Report Date: 08/24/2021
Date Signed: 08/24/2021 03:08:53 PM

Document Has Been Signed on 08/24/2021 03:08 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:CUDDLE CARE HOMEFACILITY NUMBER:
306000629
ADMINISTRATOR:NELLIE MAE CAUDLEFACILITY TYPE:
740
ADDRESS:416 E. CHESTNUT AVE.TELEPHONE:
(714) 282-8951
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 5CENSUS: 2DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Nellie Mae Cuddle, AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual visit. LPA arrived at the facility was greeted and granted entry into the facility by Administrator. LPA met with Nellie Mae Cuddle, Administrator and explained the nature of the visit.

LPA Martinez accompanied by Administrator toured the facility. There are two residents in care and no active covid-19 case in the facility. LPA observed residents in their bedrooms. Residents appeared clean and well taken care of. LPA observed a check in station in the main entry of the facility. LPA observed required department postings, covid-10 precautionary postings, and hand washing signs in the restrooms. All restrooms were observed to have soap and appeared clean. Residents bedrooms appeared clean and sanitary with all required components. Facility is taking covid-19 precautionary measures daily. LPA observed the emergency disaster and evacuation plan posted. Facility has emergency food supply, water and PPE supplies. Facility has completed the LIC808 Mitigation Plan and LPA Martinez reviewed/approved the plan on site.

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

An exit interview was conducted, this report was reviewed with Administrator and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2021
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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