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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001402
Report Date: 11/06/2024
Date Signed: 11/07/2024 12:26:59 PM

Document Has Been Signed on 11/07/2024 12:26 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:ALICIA CAREFACILITY NUMBER:
306001402
ADMINISTRATOR/
DIRECTOR:
SAEED, MUHAMMAD ANWARFACILITY TYPE:
740
ADDRESS:29742 ANA MARIATELEPHONE:
(949) 249-6610
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 3DATE:
11/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Muhammad SaeedTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Muhammad Saeed and explained the reason for the visit. The Administrator's Certificate expires on December 28, 2025. Facility has 6 bedrooms, 2 are for staff and 4 are for residents, 2 private resident rooms and 2 shared resident rooms, 3 bathrooms (2 for residents) living room, dining room, kitchen and a 2 car garage. LPA and Administrator toured the facility. LPA observed the See Something. Say Something poster posted by the front door. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed cleaning supplies are kept locked under the kitchen sink. LPA observed knives are kept locked in a cabinet. LPA observed the fire extinguisher in the kitchen is fully charged. LPA observed medications are kept locked in a cabinet. LPA observed all the resident rooms had the required furnishings. LPA observed extra linens and towels stored in the hall closet. LPA observed both resident bathrooms are clean and operational. Hot water measured 105.0 degrees Fahrenheit. LPA and the Administrator toured the garage. The garage is kept locked and used for storage. LPA observed a 3 day supply of emergency food and water. LPA and Administrator toured the backyard. The exit gate is operational No bodies of water observed. There is a small shed in the backyard that is used for storage. There is a covered patio with seating to sit outside. No obstacles or hazards observed in the backyard. LPA reviewed 3 resident files. All resident files were complete and had the required documents. LPA reviewed 2 staff files. Both staff members have the required training including CPR. No discrepancies observed. Both staff members are background cleared and associated to the facility. The last emergency drill was conducted in September 5, 2024. Smoke detectors/carbon monoxide detectors tested operational. Facility has a tablet for dedicated resident use. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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