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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006153
Report Date: 07/07/2023
Date Signed: 07/07/2023 06:58:13 PM

Document Has Been Signed on 07/07/2023 06:58 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:CARE JANELLAFACILITY NUMBER:
306006153
ADMINISTRATOR:CALANGI, KARMIANFACILITY TYPE:
740
ADDRESS:17072 SAGA DRIVETELEPHONE:
(714) 683-4617
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 6CENSUS: 6DATE:
07/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Karmian Calangi- Co-Licensee/AdministratorTIME COMPLETED:
07:15 PM
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Licensing Program Analyst (LPA) Jessica Cho made a subsequent visit for the purpose to issue a citation after observing a deficiency while conducting a 10-day complaint investigation into complaint control number: 22-AS-20230630115900. Approximately 3:35pm, LPA explained the reason for the Case Management visit to Co-Licensee/Administrator (CL/Admin) Karmian Calangi and Interim Administrator (IA) Leonora Cheryll Amorsolo Librada. LPA explained the following:

During the 10-day visit conducted on July 7, 2023, LPA was greeted and granted entry by Staff #1 (S1) followed by Staff #2 (S2), and Visitor #1 (V1). Per review of the Department's Licensing Information System (LIS) Facility Personnel Report Summary printed on July 3, 2023, S1, S2, and V1 were not listed on the roster. LPA verified that S1 was fingerprint cleared however was not associated at the time LPA arrived for the 10-day visit. S2 completed the live scan process, however was not fingerprint cleared and also not associated to the facility. V1 stated that they were visiting their friend, Staff #3 (S3), who was at the market. LPA observed V1 assisting in the kitchen prepping food. Upon review of the Department's Guardian Background Check with CL/Admin Calangi and IA approximately 4:45pm, four additional names were added on July 7, 2023 which includes S1 and S2 with S2 determined to be "In Process." CL/Admin acknowledged associating four names after receiving a phone call from the LPA at 10:55am and 11:13am and were added prior to coming to the facility to meet with LPA. Per Title 22 Regulation 87355 Criminal Record Clearance, all individuals subject to a criminal record review shall prior to working, residing, or volunteering at a licensed facility obtain a California clearance and request a transfer of a criminal record clearance, therefore the preponderance of evidence standard has been met for S1, S2, and V1.


SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2023
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CARE JANELLA
FACILITY NUMBER: 306006153
VISIT DATE: 07/07/2023
NARRATIVE
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Based on the observations, interviews conducted, and the records reviewed, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. See LIC809D. An immediate CIVIL PENALTY (LIC421BG) is being assessed.

An exit interview was conducted with Co-Licensee/Administrator Karmian Calangi, and a copy of this report along with the LIC809C, LIC809D, LIC421BG, LIC811, and the appeal rights were provided during this visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2023 06:58 PM - It Cannot Be Edited


Created By: Jessica Cho On 07/07/2023 at 05:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CARE JANELLA
FACILITY NUMBER: 306006153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/08/2023
Section Cited
CCR
87355(e)(1)

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87355 Criminal Record Clearance (e) "All individuals subject to a criminal record review...(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department..."
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Licensee to provide S2's proof of clearance to LPA via emaill by POC due date and to submit an Acknowlegement of Understanding regarding the said deficiency and for visitors assisting with the operation of the facility without proper clearance.
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This requirement is not met as evidenced by:
Based on observations, interviews, and record review, two out of three individuals, S2 & V1, were not fingerprint cleared prior to working or visitng the facility which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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Type A
07/08/2023
Section Cited
CCR87355(e)(2)

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87355 Criminal Record Clearance (e) "All individuals subject to a criminal record review...(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance..."
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This requirement is not met as evidenced by: Based on observations, interviews, and record review, one out of the three individuals, S1, was not associated prior to working at the facility which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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Licensee to associate S1 and to provide proof to LPA via email by POC due date and to submit an Acknowlegement of Understanding regarding the said deficiency. S1 was assoicated on today's date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Jessica Cho
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023


LIC809 (FAS) - (06/04)
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