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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004826
Report Date: 01/08/2025
Date Signed: 01/08/2025 11:46:37 AM

Document Has Been Signed on 01/08/2025 11:46 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ORANGEWOOD GUEST HOMEFACILITY NUMBER:
306004826
ADMINISTRATOR/
DIRECTOR:
MEL CARBAJAL MIN FAJARDOFACILITY TYPE:
740
ADDRESS:1598 W. ORANGEWOOD AVE.TELEPHONE:
(714) 583-8965
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 5DATE:
01/08/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Ruben CarbajalTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 01/08/2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to complete the annual visit that was started on 12/26/2024. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Ruben Carbajal. LPA Vanegas began to observe resident rooms and observed the following.

All resident rooms are clean and sanitary, and have enough space to accommodate enough storage space and space to move freely throughout the rooms. LPA Vanegas observed all resident rooms to have the required furnishings such as a night stand, chest drawer, lamp, chairs, enough closet space to store personal belongings, and a bed with linens that are in good repair meaning no strains or tears.

LPA Vanegas reviewed PNI with administrator Melissa Carbajal and everything added up to the correct balance that was documented. LPA Vanegas reviewed two staff files and five client files all staff files had the required documentation and required training. LPA Vanegas observed all client files to have the paperwork that is required and up to date documents were recorded.

LPA Vanegas reviewed medications and per LPA Vanegas review medications are being centrally stored, locked and inaccessible to clients in care. Per LPA Vanegas review medications are being administered per physicians orders. LPA Vanegas interviewed one client and one staff member. LPA Vanegas observed first aid kit to have all required equipment such as bandages, adhesive tape, scissors, a thermometer, and tweezers.

Based on the observations made during today’s inspection, deficiencies are not being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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