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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003585
Report Date: 12/18/2024
Date Signed: 12/18/2024 02:10:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/18/2024 02:10 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CALIFORNIA GUEST HOME IIFACILITY NUMBER:
306003585
ADMINISTRATOR/
DIRECTOR:		LUMING GUSTAVEFACILITY TYPE:
740
ADDRESS:1150 N. HARDING STREETTELEPHONE:
(714) 923-4692
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 6CENSUS: 0DATE:
12/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Luming GustaveTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility for the purpose of conducting an unannounced Required 1 Year Inspection. LPA was greeted and granted entry. Administrator stated the facility has not has residents in care since before COVID. Administrator was informed to contact Community Care Licensing (CCL) when facility is ready to accept new residents and/or of any changes to the license or if they decide to close the facility. The annual licensing fee has been paid in full and was verified via the Licensing Information System.

The facility is a single level structure and licensed for six non-ambulatory residents. LPA toured the interior and exterior portions of the facility and confirmed no residents in care. The Administrator and their family are occupying the facility. LPA reiterated to Administrator to report to Community Care Licensing Division (CCLD) prior to accepting new residents in order to conduct a follow-up health and safety inspection.

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

LPA Mason conducted an exit interview with Administrator Luming Gustave, and a copy of this report was provided during this visit.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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