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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006153
Report Date: 08/31/2023
Date Signed: 08/31/2023 12:00:56 PM

Document Has Been Signed on 08/31/2023 12:00 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: 5DATE:
08/31/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Leonora Amorsolo- AdministratorTIME COMPLETED:
12:12 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jessica Cho continued the visit after delivering the findings into Complaint Control #: 22-AS-20230714131828. The purpose of this subsequent visit was to issue a citation after initially observing a deficiency on July 7, 2023 while conducting the complaint investigation in connection to Complaint Control #: 22-AS-20230630115900. LPA met with Administrator Leonora Cheryll Amorsolo and explained the reason for the case management visit. The following was reviewed:

The purpose of this visit is to discuss new construction within the facility. On July 7, 2023, LPA discovered facility constructing a staff bedroom. Construction began on June 27, 2023 and was completed on July 10, 2023. As of today, facility now has five bedrooms instead of four. Licensees Janella Cervania and Karmian Calangi stated that the addition of the new staff bedroom was not reported to the Department prior to the construction. On today's date, facility is operating outside the limits of the approved fire clearance, therefore the preponderance of evidence standard has been met. Admin will follow up with the Fire Marshall, or the local fire authority, to schedule a fire clearance for the addition of the new bedroom.

A deficiency is being cited as per Title 22, Division 6, Chapter 8 of the California Code of Regulations. See the attached LIC809D.


An exit interview was conducted with Administrator Leonora Amorsolo, and a copy of this report was sent electronically to Administrator Amorsolo at the end of the visit.



SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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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Document Has Been Signed on 08/31/2023 12:00 PM - It Cannot Be Edited


Created By: Jessica Cho On 08/31/2023 at 11:55 AM
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: 08/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/01/2023
Section Cited
CCR
87305(b)

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87305 Alterations to Existing Building or New Facilities (b) The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists.
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Administrator to submit the LIC200, updated facility sketch, a letter requesting a fire clearance along with $25 check payable to DSS mailed to the Department by POC due date.
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This requirement was not met as evidenced by: Based on LPA's observations and interviews, the addition of the staff bedroom was not cleared by the local fire authority which poses an immediatel Health, Safety, or Personal Rights risk to persons in care.
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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: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023


LIC809 (FAS) - (06/04)
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