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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004739
Report Date: 06/18/2024
Date Signed: 06/18/2024 02:11:43 PM

Document Has Been Signed on 06/18/2024 02:11 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:AIMELY VILLAFACILITY NUMBER:
306004739
ADMINISTRATOR/
DIRECTOR:		RAUL F. REYESFACILITY TYPE:
740
ADDRESS:4712 SCHOOL STREETTELEPHONE:
(714) 553-9977
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 6CENSUS: 5DATE:
06/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Imelda Reyes
Raul Reyes		TIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analysts (LPA) Jerome Haley conducted an unannounced visit to the facility to complete the required Annual inspection. LPA Haley met with Licensee/Administrator Raul Reyes and Imelda Reyes and toured the facility.

The facility has a capacity of 6, of which 5 can be non-ambulatory and 1 may be bedridden. The facility phone number 714.340.3341

Structure: The facility is one level structure with five bedrooms. Currently four bedrooms are being occupied by residents and 1 bedroom is being used by staff.
Kitchen: Clean and organized. Sharps locked under the stove. A perishable food supply was observed in the refrigerator and freezer. Non-perishable food supply was observed in the cabinets.
Stove/Appliances:
There’s one stove with 4 burners, a refrigerator, dishwasher, microwave, washer, and dryer. All appliances are clean and operational.
Toxins:
All cleaning supplies and chemicals are locked under the kitchen sink. An additional supply of hazardous cleaning items are locked in a cabinet in the garage.
Medications, First-Aid Kit: Resident medications are locked in a filing cabinet in the office area next to the front door. There’s a brand new first aid kit in on the desk in the office area.
Resident & Staff Files: The Resident and Staff Records are kept in the office area with the medications and the first aid kit.
Bedrooms: Resident bedrooms were clean, organized and were in compliance with regulation guidelines.
Bathrooms: Both bathrooms have a working toilet, wash basin and shower. Grab bars were tightly secured to the wall.
Continued on LIC809C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: AIMELY VILLA
FACILITY NUMBER: 306004739
VISIT DATE: 06/18/2024
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Hot Water: Hot water was measured in the range of 114.2 – 115.3 degrees F.
Hygiene Supplies: The facility has an adequate supply of hygiene items locked in a a bathroom cabinet.
Linens, Hygiene, Emergency Supplies: Additional linens for each resident is stored in the bathroom, and in the linen closet in the hallway. An emergency supply of water was observed in the dining room.
Emergency Evacuation Drills: An emergency evacuation drill was conducted earlier this year and the second drill, for the second quarter will be conducted before the end of the month.
Medication Review: Medication was reviewed for all five residents.
Resident File Review: A file review was completed for all five residents.
Staff File Review: 4 staff files were reviewed during the visit.
Garage: The garage is used to store miscellaneous facility items. Walkways were free of obstruction. A washer and dryer was observed. There’s a locked cabinet with additional cleaning supplies, bleach, and detergents. There’s an additional refrigerator with an additional supply perishable food items.
Backyard: Clean, organized and walkways are free of obstruction. There was a table with a sunshade and chairs.
Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors and the carbon monoxide detector tested operational. There’s a fully charged fire extinguisher mounted on the wall near the front door, in the hallway, and monnted in the wall in the kitchen.
Misc (P&I): N/A. The facility does not manage any of the resident’s money.
Ciation(s) & TV/TA: No citations were observed during today’s inspection.
Exit Interview: Exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
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