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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006079
Report Date: 03/11/2025
Date Signed: 03/11/2025 04:23:43 PM

Document Has Been Signed on 03/11/2025 04:23 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:HEALING STEPS GUEST HOMESFACILITY NUMBER:
306006079
ADMINISTRATOR/
DIRECTOR:
JOHN CLARENCE ORTIZFACILITY TYPE:
740
ADDRESS:8184 CAROB STTELEPHONE:
(657) 256-1233
CITY:CYPRESSSTATE: CAZIP CODE:
90630
CAPACITY: 6CENSUS: 6DATE:
03/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:35 PM
MET WITH:John Clare Ortiz - AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Jerome Haley arrived to conduct an unannounced Case Management visit. LPA Haley explained the reason for the visit before entering the facility.

After entering the facility, LPA was led on a tour of the facility with staff. There were six residents present at the time of the Case Management visit. All residents were observed during the visit. Two residents were observed in the living room including Resident 1 (R1) who was on the couch sleeping. One resident was walking around the facility and the other three residents were observed in their bedroom.

Staff was asked about R1 during the visit. According to staff, R1 is quiet, but responsive to questions. Staff says there are lot of questions for the resident as they are getting to know R1 and trying to figure out what the resident likes. Staff claim R1 eats well, takes their medications, and likes to sit in the living room. R1’s nephew coordinated the transfer of R1 to the facility and has been to the facility to visit twice since the resident arrived.

Staff provided relevant documents for R1 and additional documents will be emailed to LPA Haley.

No deficiencies are being cited as a result of today’s Case Management visit.

An exit interview was conducted, and a copy of this report and LIC811 was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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