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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004265
Report Date: 05/17/2022
Date Signed: 05/17/2022 10:39:09 AM

Document Has Been Signed on 05/17/2022 10:39 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:CARING PARTNERS IIFACILITY NUMBER:
306004265
ADMINISTRATOR:PRONDA, EDSYLFACILITY TYPE:
740
ADDRESS:20082 PORT CIRCLETELEPHONE:
(657) 301-2481
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 6CENSUS: 5DATE:
05/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Arlene Farjardo, AdministratorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by caregiver and LPA explained the nature of the visit. Arlene Fajardo, Administrator arrived shortly after and met with LPA.

LPA Martinez accompanied by Administrator began the tour of the inside and outside of the facility. There are five residents in care and there is no active covid-19 case in the facility. Upon entry LPA observed a check in station with temperature checks. LPA observed two residents having breakfast and three residents in living room watching television. All residents appeared to be clean and well taken care of. LPA observed required Department postings, covid-19 precautionary postings in the facility. LPA inspected resident restroom and observed handwashing signs posted and appeared to be clean. Restroom were observed to have all required components as well as soap and sanitation precaution. LPA inspected residents’ bedrooms and they appeared to be clean and sanitary. All bedrooms observed to have all required components. LPA observed facility is taking temperatures daily and documenting the results. LPA observed the emergency disaster and evacuation plan posted. The facility has a supply of emergency food and water in attached garage. PPE supply is stored in attached garage and in facility storage. LPA toured the outside of the facility and observed shaded seating area for the residents’ enjoyment. The facility has completed and submitted the LIC808 Mitigation Plan. The plan was reviewed and approved on March 10, 2021 by the Department.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2022
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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