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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006414
Report Date: 03/05/2025
Date Signed: 03/05/2025 04:08:45 PM

Document Has Been Signed on 03/05/2025 04:08 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:DORSETT SENIOR MANORFACILITY NUMBER:
306006414
ADMINISTRATOR/
DIRECTOR:		ACASIO, ARMIN CLAIREFACILITY TYPE:
740
ADDRESS:8831 DORSETT DRTELEPHONE:
(214) 476-6864
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 6CENSUS: 5DATE:
03/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Maribel SalazarTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On March 5th, 2025 Licensing Program Analyst (LPA) William Vanegas made and unannounced inspection for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Maribel Salazar. LPA Vanegas set up equipment and began a tour of the facility and observed the following.

This is a one storied home with six bedrooms one of which is a staff room, and five of which are resident rooms. Two bathrooms one for resident use only, and one shared bathroom for visitors, staff, and residents if they wish to use it. There is an attached two car garage, and a large backyard in the facility. LPA Vanegas observed kitchen area to be clean and free of debris and mildew. LPA Vanegas observed there to be a microwave, washer, dryer, gas stove, and refrigerator to be in good repair and tested operational. LPA Vanegas observed a two day supply of perishable food, and a seven day supply of non-perishable food, and a sufficient amount of emergency water.

LPA Vanegas observed resident bathrooms to be clean and free of debris and mildew. LPA Vanegas observed water faucets and toilets to be operational, and for resident bathroom to have all required furnishings such as grab bars, shower chair, and slip resistant matts. Facility water tested between 111.5 and 116.2 degrees.

LPA Vanegas observed resident bedrooms to have all required furnishings such as a chair, lamp, bed, and linens in good repair; meaning no strains or tears. Resident rooms are large enough to walk freely in them, and entry ways are not blocked by any obstructions.

CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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: DORSETT SENIOR MANOR
FACILITY NUMBER: 306006414
VISIT DATE: 03/05/2025
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LPA Vanegas observed fire extinguishers to be fully charged, and up to date. LPA Vanegas observed there to be smoke and carbon monoxide detectors in every room. All tested operational and were in good repair. LPA Vanegas observed all toxins, sharps, and medications to be locked away and inaccessible to residents in care. LPA Vanegas observed outside of the facility to be clean and free of any debris or obstructions along emergency exit pathway. There is an outdoor shaded sitting area, and backyard is large enough to participate in outdoor activities upon residents request. Side doors are self latching and unlocked.

LPA Vanegas reviewed medications with CG Maribel Salazar, and per LPA review all medications are being documented correctly and are being administered per physicians orders. LPA Vanegas reviewed first aid kit and observed first aid kit to have all required items such as adhesive tape, bandages, tweezers, scissors, a thermometer, and a first aid manual. LPA Vanegas reviewed three staff files, and five resident files. All staff annual training is up to date and filed correctly.

Based on observations made during today's inspection no deficiencies will be cited per title 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
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