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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001351
Report Date: 08/08/2024
Date Signed: 08/08/2024 03:52:28 PM

Document Has Been Signed on 08/08/2024 03:52 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:TESS LOVING HOME IIFACILITY NUMBER:
306001351
ADMINISTRATOR/
DIRECTOR:
MARITES VILLANUEVAFACILITY TYPE:
740
ADDRESS:2785 E. DIANA AVE.TELEPHONE:
(714) 630-0999
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 6CENSUS: 4DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Marites VillanuevaTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to conduct the Required 1-Year evaluation. LPA was greeted and granted entry into the facility by Administrator (AD) Marites (Tess) Villanueva and reason for visit was explained. There were 4 residents present during today's visit.

The facility is a single story home with an attached garage, four resident bedrooms, two resident bathroom, one staff bedroom, kitchen, dining room and family room. Of the four resident's in care, AD reported only one resident is receiving Hospice services. LPA along with AD conducted a tour of the inside and outside of the facility, and observed the following: LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature. Lighting is sufficient for safety and comfort. LPA observed a table and chairs in covered back patio area for residents and visitors. Bedrooms were observed to be spacious and easily accommodate furnishings such as lamps, chair, dresser and a bed. Bathrooms were observed to be clean, have a supply of soap and paper towels. Hot water temperature was within regulatory requirements. Linen and hygiene supplies were stocked. 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. Smoke detectors and carbon monoxide detectors were found to be operational. Fire Extinguishers were charged and mounted. Stove burners, dishwasher, microwave, washer, and dryer are operational. Chemicals and sharps are made inaccessible to the residents. Laundry is done in laundry room adjacent to kitchen. LPA verified that Dementia safeguards were in place, such as alarms on exit doors and locked areas for toxins and hazardous items. Medications are centrally stored in a locked cabinet in laundry room. Medications reviewed appear to have been dispensed accurately. LPA interviewed 4 of 4 residents and one staff. Resident and staff files were reviewed. LPA confirmed Administrator has a current Administrator's certificate which expires 12/12/2025.

Based on the observations made during today's visit, no deficiencies are being cited. An exit interview was conducted with AD Villanueva and a copy of this report was provided at the end of the visit via email.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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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