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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005591
Report Date: 06/17/2024
Date Signed: 06/17/2024 04:27:05 PM

Document Has Been Signed on 06/17/2024 04:27 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:LIVING THE DREAM CARE HOMEFACILITY NUMBER:
306005591
ADMINISTRATOR/
DIRECTOR:
RADU, CRISTINA SFACILITY TYPE:
740
ADDRESS:17391 BONNER DRTELEPHONE:
(714) 734-6501
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 6CENSUS: 6DATE:
06/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Cristina RaduTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 1:30 PM, LPA Tea was greeted and granted entry into the facility by caregiver, Eliana Quadros and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for four. Currently there are six residents, of which one is on hospice during today's visit. The Administrator, Cristina Radu arrived shortly after to assist during the visit.

At 1:45 PM, LPA Tea reviewed six resident files and two staff files. There were discrepancies noted in the review of resident and staff files. Administrator certificate expired on March 22, 2024 however administrator has complied with all course work and is pending renewal at this time.



LPA Tea along with the Administrator toured the facility at 9:41 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 5 resident bedrooms, which one is shared, 2 full bathrooms and 1 half bathroom, living room, dining room, and kitchen. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured between 108.5 F degrees and 110.1 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be locked and inaccessible to clients in care locked and secured underneath the kitchen sink. Fire extinguishers are fully charged.

Continuation on LIC809-C

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
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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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: LIVING THE DREAM CARE HOME
FACILITY NUMBER: 306005591
VISIT DATE: 06/17/2024
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Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating and the exit gate is self-latching and operational. LPA observed emergency food and water supply in the garage. There is PPE equipment in the backyard shed and they have a emergency backup generator. Facility provides activities in the form of outdoor activities such as going out for walks and doing exercises. The residents play games and like to watch tv and sing karaoke.

At 3:25 PM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the kitchen. Medications are being administered per physician order. LPA interviewed clients regarding their quality of care and spoke to staff present regarding care provided.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with caregiver Eliana Quadros and a copy of this report LIC809, 809-C, LIC858, LIC859, LIC9102 was read and provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC809 (FAS) - (06/04)
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