306006339-9-20-2024-22-AS-ARJR-D9AV6V-20240920161010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006339
Report Date: 09/20/2024
Date Signed: 09/20/2024 04:10:16 PM

Document Has Been Signed on 09/20/2024 04:10 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:	OC VILLAS - LINDA VISTA		FACILITY NUMBER:	306006339
ADMINISTRATOR/ DIRECTOR:	ROMAN, ELSA		FACILITY TYPE:	740
ADDRESS:	1184 N LINDA VISTA ST		TELEPHONE:	(562) 607-4077
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY: 6		CENSUS: 5	DATE:	09/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Angelamari Locsin-Caregiver, Maybelyn Alapar-Caregiver, Elsa Roman-Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:24 PM

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Caregiver Angelamari Locsin. Administrator (AD) Elsa Roman arrived shortly after.

For today’s visit, LPA observed a total of five residents in care and two staff members on duty.

LPA observed the Administrator's Certificate for Elsa Roman which expired on 6/23/24, however, AD provided proof of payment to show that the certificate is in renewal process. Renewed certificate has not yet been received and is pending. LPA reminded Licensee to post certificate once received.

LPA Ramirez toured the interior and exterior portions of the facility with caregiver. The facility is a single level structure and is licensed for six non-ambulatory residents, of which two may be on hospice and zero bedridden. There are a total of six bedrooms, of which six are resident bedrooms. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of two restrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 105.9-107.2 degrees Fahrenheit.

During today's visit LPA observed as a caregiver was reading a book to the residents in the living room.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers were charged and one was located by the kitchen and one by the residents' bedroom hallway.

CONTINUED ON LIC809-C..

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

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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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: OC VILLAS - LINDA VISTA	FACILITY NUMBER: 306006339
	VISIT DATE: 09/20/2024

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LPA observed the emergency disaster and evacuation plan which is located by the entrance seating area. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care.

For the exterior portion, LPA Ramirez observed a shaded area, patio furniture, and the grounds were free of any hazards. There are two gates in the backyard, which both are self-closing and self-latching. No bodies of water were observed.

LPA reviewed five resident files and two staff files. LPA interviewed residents and staff present.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Roman.

A copy of this report was provided at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

LIC809 (FAS) - (06/04)

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