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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005874
Report Date: 02/14/2025
Date Signed: 02/14/2025 10:21:44 AM

Document Has Been Signed on 02/14/2025 10:21 AM - 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:BUBBE AND ZAYDE'S PLACE, INCFACILITY NUMBER:
306005874
ADMINISTRATOR/
DIRECTOR:		CURKIN,SETH&CAGAN,SHIMONFACILITY TYPE:
740
ADDRESS:1541 EAST 20TH STREETTELEPHONE:
(714) 543-3939
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 1DATE:
02/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:07 AM
MET WITH:Supervisor Juana GonzalezTIME VISIT/
INSPECTION COMPLETED:
10:36 AM
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Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Seth Curkin was notified via telephone but could not arrive to assist with the inspection. LPA observed that Administrator Seth Curkin has a valid Administrator certificate which expires August 21, 2026.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, and has a hospice waiver for six. The facility is a single story home with three resident bedrooms, one of which is shared, two resident bathrooms, both are which are shared, a living room, a dining room, a kitchen, a laundry room, and an attached two car garage. LPA, accompanied by a care giving staff conducted a tour of the interior portion of the facility. On today's visit, LPA observed one resident in care and two care giving staff present. LPA observed the resident relaxing in a common area. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all three resident bedrooms and they were observed to be free of any hazards. LPA observed the resident bedrooms had all the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens and blankets are stored in a closet in the resident hallway. LPA inspected the two shared resident bathrooms. Resident bathrooms are clean. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 109.5 and 110.3 degrees Fahrenheit.

LPA observed that the kitchen has a two day perishable and a seven day nonperishable food supply on hand. The kitchen is clean and appliances were operational. LPA observed the four top electric stove to be operational at the time of visit. LPA observed kitchen knives to be stored in a locked kitchen cabinet. LPA observed toxins and chemicals to be stored in a locked kitchen cabinet under the sink.
CONTINUED ON LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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: BUBBE AND ZAYDE'S PLACE, INC
FACILITY NUMBER: 306005874
VISIT DATE: 02/14/2025
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A fire extinguisher is located in the kitchen and in the resident hallway. Fire extinguishers were observed to be charged and serviced as of March 12, 2024. LPA tested the dual smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 21, 2025. The centrally stored medication is kept in a locked closet in the living room. LPA observed a First Aid Kit to be stored in the locked closet and it was observed to have all the required components. LPA observed a fireplace in the living room and it was observed to be adequately fenced and not in operation at time of visit. LPA inspected the laundry room and observed chemicals and toxins to be stored in a locked cabinet. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage.

LPA, accompanied by a care giving staff conduct a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the west side of the facility is self-latching and can be open in an evacuation. There are no bodies of water on the premises.

LPA reviewed the one resident file. All the required documentation was present and current in the resident file reviewed. LPA reviewed the one residents' medication and medication record. LPA reviewed two staff files. All staff are background cleared and associated to the facility.

Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. LPA spoke with Administrator Seth Curkin via telephone who authorized Supervisor Juana Gonzalez to sign the report. An exit interview was conducted with Supervisor Juana Gonzalez and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
LIC809 (FAS) - (06/04)
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