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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006148
Report Date: 09/04/2024
Date Signed: 09/04/2024 12:16:23 PM

Document Has Been Signed on 09/04/2024 12:16 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:GRAND VIEW VILLAS INC.FACILITY NUMBER:
306006148
ADMINISTRATOR/
DIRECTOR:
AMLANI, ROZINAFACILITY TYPE:
740
ADDRESS:25262 VIA DE ANZATELEPHONE:
(714) 348-4793
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 5DATE:
09/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:16 AM
MET WITH:Rozina AmlaniTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Facility is a single story home with 7 bedrooms (1 is for staff) and 7 bathrooms, kitchen, dining room, living room with a screened fireplace and a two car garage. The garage is used for storage and kept locked. LPA observed the See Something, Say Something poster posted in the entry way of the facility. LPA and the Administrator toured the facility. LPA observed all bathrooms are clean and operational. Hot water measured 112.0 degrees Fahrenheit to 115.0 degrees Fahrenheit. LPA observed the kitchen is clean and organized. LPA observed a two day perishable and a 7 day non-perishable food supply on hand in the kitchen. The knives are kept locked in a kitchen drawer. Cleaning supplies are kept locked under the kitchen sink. LPA observed the medication is kept locked in the hall closet. The fire extinguisher in the kitchen is fully charged. The smoke detectors and carbon monoxide detector tested operational. LPA and the Administrator toured the resident rooms. All resident rooms had the required furnishings. LPA toured the garage. The garage is used for extra supplies and emergency food and water. The garage is kept locked. LPA toured the backyard. There is a raised fountain in the backyard. LPA observed a shaded seating area with tables and chairs to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPA reviewed 3 staff files, all staff are background cleared and associated to the facility. All staff had the required training including CPR training. LPA reviewed 5 resident files, no discrepancies observed. LPA reviewed 5 resident medications and medication records. No discrepancies observed. LPA inspected the first aid kit, the first aid kit has all the required elements. LPA verified the facility has WiFi. LPA verified with the Administrator that the facility does not have an internet device dedicated for internet use. LPA consulted with the Administrator concerning reporting requirements and resident rights. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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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