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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003850
Report Date: 12/16/2024
Date Signed: 01/09/2025 09:45:35 AM

Document Has Been Signed on 01/09/2025 09:45 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:WHISPERING OAKS - WAVERLYFACILITY NUMBER:
306003850
ADMINISTRATOR/
DIRECTOR:		IMELDA C. CAROFACILITY TYPE:
740
ADDRESS:14782 WAVERLY LANETELEPHONE:
(714) 931-1945
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 6CENSUS: 5DATE:
12/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Imelda Caro - Administrator TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On this day Licenscing Program Analyst (LPA) Andrea Mendivil made an unannouced visit to conduct a required annual visit. LPA Mendivil was greeted and granted entry into the facility by Caregiver Leo M and explained the reason for the visit. Administrator Imelda Caro arrived at 8:48am.
At 8:40 am LPA Mendivil toured the facility with Caregiver Leo. The facility is 6 bedrooms, 3 bathroom, one story home with an attached garage. LPA Mendivil inspected the residents’ bedrooms. LPA Mendivil observed that the bedrooms were clean, lights were operational, and furniture were in good conditions. LPA Mendivil observed that the bathrooms; toilets and sinks were clean. LPA Mendivil tested the hot water in three (3) bathrooms. The hot water temperature was recorded at: 105.5 Fahrenheit degrees,106.5 Fahrenheit degrees, and 111.0 Fahrenheit degrees.

LPA Mendivil inspected the kitchen. LPA Mendivil observed that the facility had a two-day supply of perishable food and a supply of seven-day of non-perishable foods as required. LPA Mendivil tested the facility smoke detectors and carbon monoxide detectors the detectors were operational. LPA Mendivil observed that the administrator has a current administrator certificate. LPA Mendivil observed the poster PUB 475 Let Us No and LTCO (Long Term Care Ombudsman) in hallway, visible to the public. LPA Mendivil observed that toxic chemicals were kept in a locked cabinet and the chemicals were not accessible to residents. LPA Mendivil inspected the garage and observed that emergency food and water.. LPA Mendivil observed secured and locked medication cabinet. LPA Mendivil observed that the resident’s medications were labeled. LPA Mendivil reviewed residents’ records and files. Therefore, and based on the observations made during this annual inspection conducted per Title 22 of the California Code of Regulations, no citations were issued. An exit interview was conducted with the administrator Imelda Caro and a copy of this report was provided to administrator.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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