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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005845
Report Date: 06/10/2024
Date Signed: 06/10/2024 02:14:26 PM

Document Has Been Signed on 06/10/2024 02:14 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:SANTA MARIANA CAREFACILITY NUMBER:
306005845
ADMINISTRATOR/
DIRECTOR:		LIMPIADO, GIDEONFACILITY TYPE:
740
ADDRESS:18676 SANTA MARIANATELEPHONE:
(949) 349-8708
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 6CENSUS: 6DATE:
06/10/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:11 PM
MET WITH:Rhoda Yturralde, Caregiver and Roel Atanacio, House Manager TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced Case Management Health and Safety check visit on today's date. LPA Quiroz was greeted by Caregiver Rhoda Yturralde and discussed the purpose for the visit. House Manager (HM) Roel Atanacio arrived shortly after.

LPA Quiroz toured the inside and exterior of the facility and no immediate health/safety hazards were observed. LPA Quiroz inspected resident bedrooms and interviewed with residents who stated they had no complaints. LPA Quiroz observed 12 residents playing bingo in the back yard area. (HM) Atanacio indicated "6 additional residents are visiting from other sister facilities. We started joining the facilities together for games and socialization time." LPA Quiroz inspected facility food supply and was observed to be in quantity to meet the regulatory requirements during this inspection.



Staffing was observed as House Manager and five caregivers present during today's visit.


No deficiencies are being cited in the areas observed during today's visit.

LPA Quiroz conducted an exit interview with House Manager Roel Atanacio, and a copy of this report was provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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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