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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004645
Report Date: 07/12/2021
Date Signed: 07/12/2021 12:30:27 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/12/2021 12:30 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:ORANGE HILL QUALITY CARE, LLCFACILITY NUMBER:
306004645
ADMINISTRATOR:LUIZA MICUFACILITY TYPE:
740
ADDRESS:113 S. ORANGE HILL LANETELEPHONE:
(714) 998-8264
CITY:ANAHEIM HILLSSTATE: CAZIP CODE:
92807
CAPACITY: 6CENSUS: 5DATE:
07/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH: Santana Dawkins and Janet Brissette and Luiza MicuTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Michelle Reed made an unannounced visit to the facility to conduct an Annual visit. Upon arrival, LPA met Caregivers Santana Dawkins and Janet Brissette. LPA explained the purpose of the visit. Administrator Luiza Micu was contacted via telephone and arrived at approximately 12:20pm

During the visit LPA toured the facility inside and out with Janet Brissette. LPA observed Covid signage at front entrance of facility as well as a sanitization station. Facility has required Department postings. LPA observed a copy of Administrator Certificate for Luiza Micu that expires 9/23/21. LPA toured all resident rooms. Rooms were clean and sanitary. Restrooms and rooms observed contained ample supplies of hand sanitizer, soap, wipes, gloves and paper towels. LPA observed outside visitation area with ample shading. The swimming pool present has a 5 ft fence present that meets Title 22 regulation. There were 5 resident's present. Two resident's were having lunch and 3 other's were in their beds sleeping. Licensee has required Mitigation plan and Emergency Disaster Plan. LPA also observed emergency food and water supply. Facility has a secured location for resident medication and files.

During the visit, LPA consulted about the importance of maintaining a 30 day supply of PPE on site. Additionally, LPA discussed sign in and screening procedures for visitors. LPA advised the importance of mask wearing and handwashing for staff and residents.

No deficiencies noted during visit. An exit interview was conducted and a copy of this report was provided to Luiza Micu.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2021
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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