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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003807
Report Date: 09/23/2022
Date Signed: 09/23/2022 11:35:50 AM

Document Has Been Signed on 09/23/2022 11:35 AM - 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:CHATEAU FRANCESCAFACILITY NUMBER:
306003807
ADMINISTRATOR:MARIZA OLIVAFACILITY TYPE:
740
ADDRESS:33821 VIA CASCADATELEPHONE:
(949) 234-0559
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 6CENSUS: 6DATE:
09/23/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mariza OlivaTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted by staff Maria Crespo and granted entry into the facility. LPA Gutierrez discussed the purpose of the inspection. Assistant Administrator (AAD) Ronaldo Mariano arrived at 10 a.m. During the inspection LPA Gutierrez and AAD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

This is a single-story house with five bedrooms, and two bathrooms, with one bedroom being occupied by staff. A 2-day supply of perishable and a 7-day supply of non-perishable foods was observed during today’s visit. Upon record review LPA noted emergency care requirements were met. LPA observed the facility has a 30-day supply of PPE on hand. LPA observed hallways and walkways were free of obstruction.

Administrator (AD) Mariza Oliva arrived at 10:27 a.m. During the inspection LPA also observed and obtained a picture of Resident 1 (R1) with a reddish skin condition on the left side of their head. R1 denied falling and stated they have a skin condition. Upon record review of R1’s physician report dated 6/03/2022, it was noted R1 has a history of skin condition/breakdown. AD stated they would obtain an appointment as soon as possible; a Technical Advisory was given on this date.

LPA reviewed and confirmed facility policies and practices regarding resident screening; a Technical Advisory was given on this date, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, infection control training, PPE, staffing and staffing shortages.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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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