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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005392
Report Date: 11/14/2024
Date Signed: 11/14/2024 05:34:43 PM

Document Has Been Signed on 11/14/2024 05:34 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:TAYLOR COTTAGE, THEFACILITY NUMBER:
306005392
ADMINISTRATOR/
DIRECTOR:		CATACUTAN, MARY JEANFACILITY TYPE:
740
ADDRESS:7752 TAYLOR DRIVETELEPHONE:
(614) 746-5824
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY: 6CENSUS: 5DATE:
11/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:41 PM
MET WITH:Licensee Weenie EarwoodTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
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On today’s visit, Licensing Program Analysts (LPA’s) Jenifer Tirre, Edward Kim and Licensing Program Manager (LPM) Lourdes Montoya made an unannounced visit to follow up on complaint investigation # 22-AS-20241101102846, and unrelated deficiencies were observed while touring the facility.

During inspection visit, department noted the following deficiencies not related to complaint investigation.

Per interview with the Licensee/Administrator Weenie Earwood and Staff #2 , a non-ambulatory resident (R# 3) occupies and sleeps in room #5 that is not fire clearance approved. Room does not have proper egress window for fire clearance posing a health and safety threat to resident in care. The above is being cited on attached LIC 809D and issued an Immediate Civil Penalty

During visit the following items were also observed and to be addressed at another time due to time constraints.

· Facility kitchen drawers were not closing properly

· Facility Printer was non operational.

· S1 & S2 stated they sleep in the living room

An exit interview was conducted with Administrator/Licensee Earwood and copy of report, D page and appeal rights was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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Document Has Been Signed on 11/14/2024 05:34 PM - It Cannot Be Edited


Created By: Jenifer Tirre On 11/14/2024 at 05:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: TAYLOR COTTAGE, THE
FACILITY NUMBER: 306005392

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely
Type A
11/15/2024
Section Cited
CCR
87202(a)

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(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by:
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Licensee agreed to move resident to shared bedroom number 1. Licensee providing proof via face time video call by POC due date 11/15/2024.
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 Per interview with the Licensee/Administrator Weenie Earwood and Staff #2 , a non-ambulatory resident (R# 3) occupies and sleeps in room #5 that is not fire clearance approved. Room does not have proper egress window for fire clearance posing a health and safety threat to resident in care. This poses an immediate Health and Safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lourdes Montoya
LICENSING EVALUATOR NAME:Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


LIC809 (FAS) - (06/04)
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