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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005359
Report Date: 01/26/2026
Date Signed: 01/26/2026 04:26:32 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/26/2026 04:26 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:CLOSE TO HOME SENIOR CARE IIIFACILITY NUMBER:
306005359
ADMINISTRATOR/
DIRECTOR:		PARNELL, MARICARFACILITY TYPE:
740
ADDRESS:1148 E CHESTNUT AVETELEPHONE:
(714) 872-0965
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 6CENSUS: 1DATE:
01/26/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Maricar Parnell (Administrator) TIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On today's date January 26,2026 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry by facility staff. LPA Vanegas explained the purpose of the visit, and Administrator (AD) Maricar Parnell was advised and arrived to assist with the inspection. LPA Vanegas began a tour of the facility and observed the following.

This is a one storied house with six bedrooms one of which is a caregiver room, and two bathrooms used for residents and a two car detached garage. LPA Vanegas observed kitchen area to be clean and free of debris and observed a gas stove, microwave, refrigerator, and dishwasher that tested operational. LPA Vanegas observed a two day supply of perishable food, and a seven day supply of non-perishable food along with a sufficient amount of emergency water, in an instance of a natural disaster.

LPA Vanegas observed resident restrooms to be clean and free of debris and had all the proper furnishings such as grab bars, slip resistant floor matts, and a shower chair. Toilet and water faucets tested functional and water tested between 111.2 and 114.3 degrees. LPA Vanegas observerd fire extinguisher to be fully charged and up to date. LPA Vanegas observed all smoke detectors and carbon monoxide detectors to be operational. LPA Vanegas observed washer and dryer to be operational and in good repair and all toxins were locked away and inaccessible to residents in care.

CONTINUED ON LIC809C
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2026
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 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: CLOSE TO HOME SENIOR CARE III
FACILITY NUMBER: 306005359
VISIT DATE: 01/26/2026
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LPA Vanegas toured the backyard of the facility and observed a shaded seating area, and enough space for residents to participate in outdoor activities upon their request. LPA Vanegas observed no obstructions or hazards along emergency exit route. Side doors are self latching and unlocked. LPA Vanegas toured the garage and observed organized and clean personal items belonging to caregivers and licensee.

LPA Vanegas reviewed one resident file and residents file had all required documents. LPA Vanegas reviewed three staff files and observed all staff files to have the required documentation filed and the required annual training completed.

LPA Vanegas observed medications, toxins, and sharps to be locked away and inaccessible to client in care. LPA Vanegas reviewed medications and medication administration record. Per LPA Vanegas review there were no discrepancies, and medications are being administered per physicians orders.

LPA Vanegas observed emergency disaster plan it was filled out, up to date and reviewed by facility staff. LPA Vanegas observed infection control plan to be up to date and recently reviewed. LPA Vanegas observed all required postings to be posted and in the correct dimensions. LPA Vanegas observed first aid kit and it consisted of all the required equipment including adhesive tape, scissors, a thermometer, bandages and a first aid manual.

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 with AD Maricar Parnell, and a copy of this report was left at the facility.
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC809 (FAS) - (06/04)
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