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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005273
Report Date: 11/21/2024
Date Signed: 11/21/2024 06:16:58 PM

Document Has Been Signed on 11/21/2024 06:16 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:NORA'S RESIDENCE OF PLACENTIAFACILITY NUMBER:
306005273
ADMINISTRATOR/
DIRECTOR:
DIMAANO, EUPHROSYNEFACILITY TYPE:
740
ADDRESS:1217 WARREN STREETTELEPHONE:
(714) 203-1327
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY: 6CENSUS: 6DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Teresita BaloyTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analysts (LPAs) Claudia Gutierrez and Eboni Bentley made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPAs were greeted by House Manager (HM) Teresita Daloy and granted entry into the facility. LPA Gutierrez discussed the purpose of the inspection. Administrator (AD) Euphrosyne Dimaano arrived at 8:45 am.

During the inspection LPAs and HM conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

This is a single-story house with six bedrooms, three bathrooms, one staff bedroom and attached two-car garage. LPAs observed two staff and six residents in care. Residents were observed resting in their respective rooms and eating at the dining room table. A 2-day supply of perishable and a 7-day supply of non-perishable food was observed during today’s visit. LPAs observed hallways and walkways were free of obstruction. There were no bodies of water on the premises. All resident bedrooms had the required furnishings. Additional bed linens, comforters, and bath towels were observed in the hallway storage. Bathrooms were operational and water temperature tested between 102.2- and 115.8-degrees F.

Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Electric stove, microwave, washer, and dryer were all inspected and observed to be operable. There are two fire extinguishers, both mounted and fully charged. A review of the Medication Administration Records (MARs) was conducted, and LPAs observed records are in compliance. Disaster drill log indicated last disaster drill was conducted on November 02, 2024. Smoke and carbon monoxide detectors were operational in bedrooms and common areas. LPAs reviewed six resident files and three staff files. LPAs interviewed three residents and two staff.

Based on the observations made during today’s inspection, no deficiencies are 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: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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