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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006412
Report Date: 10/01/2024
Date Signed: 10/01/2024 01:51:16 PM

Document Has Been Signed on 10/01/2024 01:51 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:ABSOLUTE ELDERLY CARE,CORP.FACILITY NUMBER:
306006412
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, ISRAELFACILITY TYPE:
740
ADDRESS:13432 WINTHROPE STREETTELEPHONE:
(714) 538-0050
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 0DATE:
10/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Isarael SanchezTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analysts (LPA) Jerome Haley made an announced visit for the purpose of conducting a pre-licensing evaluation. LPA Haley was greeted and granted entry by applicant Isreal Sanchez.

Initial application: To operate a Residential Care Facility for the Elderly, with a capacity of 6 (5 ambulatory & 1 non-ambulatory) residents was submitted to the department for licensure.



Fire clearance: Orange County Fire Authority granted the Fire Clearance April 10, 2024

Structure:
The facility is a single level structure, with an attached garage. There’s a total of 5 bedrooms, one living room space, one dining area, and three bathrooms. Bedrooms (Residents): All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Grab bars are tightly secured. Hot water temperature measured at 121.6 degrees Fahrenheit in bathroom 1. Kitchen: 5 of 6 burners were operational on the gas stove. Sharps are locked in a kitchen drawer near the resident medication drawers. Food Service: Applicant is aware of the regulation requirements regarding perishable and non- perishable food supply. Additional food items will be purchased before residents are admitted to the facility. Office Area: There's a locked office area in the backyard. In the locked office area, staff and resident files will be stored in locked filing cabinets. Laundry: There's a laundry area in the garage with a washer and dryer. Toxins: All toxic chemicals and cleaning solutions are inaccessible to residents and will be stored in the garage. Resident & Staff Files: Resident and staff files will be stored in locked filing cabinets in the locked office that’s in the backyard. Medications/First-Aid Kit: Medications will be locked in the kitchen in individually locked medication drawers. Each resident will have their own locked medication drawers. A commercial size first aid kit with all the required elements is mounted on the wall next to the medication drawers.

Continued on LIC809C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ABSOLUTE ELDERLY CARE,CORP.
FACILITY NUMBER: 306006412
VISIT DATE: 10/01/2024
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Linens & Hygiene Supplies: Adequate supply of linen was stored in cabinets in the hallway.
Backyard/Exterior:
There’s a large backyard with self-latching exit gate. A shaded patio area with a table and chairs was observed. A larger garden area surrounded by a fence was observed. All walkways were clear and free of obstruction. Bodies of Water: There’s a cold therapy tank in the backyard. Applicant was advised to place a lock on the cold therapy tank.
Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational.
Fire Extinguisher: Observed full charged mounted on the wall in the kitchen next to the lock medication drawers.

Emergency Phone Numbers, House Rules, Exit Plan & Menu:
Will be posted & readily available for review an emergency disaster plan, a list of emergency phone numbers, house rules on the facility postings board in the living room area. A sample menu will be posted in the kitchen.
Component III: Is not ready to be presented at this time. Component III will be presented after corrections are made and the follow up visit is completed.
Corrections: The applicant has corrections to make before the facility is ready to be licensed.
1) Repair or replace the stove. The top right burner on the stove is not working and the light above the stove needs to be replaced or repaired. The stove should light unassisted.
2) Remove all personal items from the resident bedrooms.
3) Adjust the hot water temperature to meet regulation requirements.
4) Post a sample menu on the refrigerator
5) Place a lock on the cold (ice/water) therapy tank
6) Wires – Secure cover on phone jack in room #1
7) Get bedframes for rooms without beds (all rooms have bed, but they are not resident beds)
8) Non-skid matts for showers
9) Facility Postings board for required items: personal rights, house rules, infection control plan, etc.
10) Emergency items (food, water, flashlights, batteries)

A follow up visit is tentatively scheduled for Tuesday, October 22, 2024.
An exit interview was conducted, and a copy of this report was provided to applicant Israel Sanchez.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
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