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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003530
Report Date: 07/01/2022
Date Signed: 07/01/2022 01:54:26 PM

Document Has Been Signed on 07/01/2022 01:54 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:GUARDIAN ANGELS HOMES IIFACILITY NUMBER:
306003530
ADMINISTRATOR:KELLY FRANCIAFACILITY TYPE:
740
ADDRESS:18232 E. SANTA CLARA AVE.TELEPHONE:
(714) 812-0137
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 6DATE:
07/01/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Licensee Sonia Garcia TIME COMPLETED:
02:07 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year infection control annual visit. LPA was greeted, granted entry by staff, and explained the reason for the visit. LPA Haley was temperature checked and screened before entering. Licensee Sonia Garcia was present for the visit. AD Kelly Francia has a current administrators certificate that expires 3/1/24.

At 12:40 AM LPA Haley and Licensee Garcia began the tour. LPA observed all required posting at the entrance and through out the facility. There's a screening station at the facility entrance with a temperature thermometer, screening log book and hand sanitizer. Further, there's screening instructions with a QR Code that can be scanned and the pre-screening process can be completed on a mobile device. There's a closet near the entrance of the facility with an emergency supply of PPE. Emergency food and water supply, and emergency bags for all the residents ready to go.

LPA Haley and Licensee began the tour of the resident bedrooms. All resident bedrooms were clean, very well organized, and had all necessary requirements. All bathrooms were clean and organized. Hot water temperatures measured between 106.7 degrees Fahrenheit and 108.5 degrees Fahrenheit.

The kitchen was clean and very well organized. All knives and sharp objects were locked in a drawer near the kitchen sink. The facility has a two day supply of perishable food items and seven day supply of nonperishable food items. There was locked medication cabinets, and a fire extinguisher that was mounted in charged.

The backyard was clean, organized, and free of clutter. Side exit gates were self closing and self latching. In the backyard, LPA Haley observed a shaded patio area with a table and chairs. There was also a table set up with hand sanitizer and paper towels. LPA Haley and Licensee Garcia observed a few mattresses and an old dresser that will be picked up and removed from the facility. LPA Haley advised licensee Garcia the importance of keeping the facility clean and free of clutter at all times.


Continued on LIC 809C Dated 7/1/22
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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: GUARDIAN ANGELS HOMES II
FACILITY NUMBER: 306003530
VISIT DATE: 07/01/2022
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There were no bodies of water observed. Smoke and carbon monoxide detectors were tested and are operational. LPA Haley will be issuing a Technical Advisory because LPA Haley and Licensee Garcia observed during the inspection that one of the burners on the stove would not light without assistance. No deficiencies are being cited during todays visit. An exit interview conducted and a copy of the report, and the LIC 9102 TA was provided to the Licensee Garcia.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022
LIC809 (FAS) - (06/04)
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