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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004802
Report Date: 03/18/2024
Date Signed: 03/18/2024 03:33:53 PM

Document Has Been Signed on 03/18/2024 03:33 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:BEST HOME CAREFACILITY NUMBER:
306004802
ADMINISTRATOR:VLAD POP, CRISTINA MARIAFACILITY TYPE:
740
ADDRESS:5433 ROME AVENUETELEPHONE:
(714) 316-4938
CITY:CYPRESSSTATE: CAZIP CODE:
90630
CAPACITY: 6CENSUS: 2DATE:
03/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Cristina Maria Vlad Pop, Licensee/AdministratorTIME COMPLETED:
03:45 PM
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 On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required Annual inspection. LPA was greeted and granted entry into the facility by Caregiver 1 (CG1) and met with Licensee/Administrator (L/AD) Cristina Maria Vlad Pop and discussed purpose of today's visit.
This is a a Residential Care Facility for the Elderly, licensed to provide services to six (6) Non-Ambulatory residents and has a hospice waiver for (5) five residents. There are currently two (2) residents in care at this time of which 2 residents are receiving hospice care services. There are no active COVID-19 cases in the facility at this time. (L/AD) Vlad Pop has an Administrator Certificate with expiration date of June 20, 2024.
LPA Quiroz along with (L/AD) Vlad Pop toured the interior and exterior of the facility. During today's inspection tour, LPA Quiroz observed Resident 1 in their bedroom resting and Resident 2 in the living room area with staff supervision. LPA Quiroz interacted and interviewed with Caregiver and 1 of 2 residents during today's visit.
LPA Quiroz inspected resident's bedrooms and bathrooms. The water temperature in 2 of 2 resident's bathrooms were recorded to be within normal limits. LPA Quiroz inspected resident's bedrooms and appeared to be clean. Facility temperature in resident's bedrooms and throughout the facility was recorded to be within normal limits. LPA Quiroz observed the emergency and disaster and evacuation plan. Facility has supply of emergency food, water and PPE in the garage area readily available for staff and residents in care. The Fire extinguisher observed last serviced on 9/6/2023. LPA Quiroz observed functional and operational washer and dryer in the laundry room area. LPA Quiroz toured the outside of the facility and observed seating and shaded area in the backyard for residents and visitor's enjoyment.
LPA Quiroz reviewed 2 of 2 resident records and 4 of 4 personnel files.
During today's visit, LPA Quiroz provided Consultation on Title 22 and Infection control. An exit interview was conducted with (L/AD) Cristina Maria Vlad Pop, and a copy of this report and LIC 811- Confidential names, were provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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