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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006467
Report Date: 03/04/2024
Date Signed: 03/04/2024 02:38:30 PM

Document Has Been Signed on 03/04/2024 02:38 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ROCKVIEW RESIDENTIAL CAREFACILITY NUMBER:
306006467
ADMINISTRATOR:BUI, DENNISFACILITY TYPE:
740
ADDRESS:8156 ROCKVIEW CIRTELEPHONE:
(714) 300-4540
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 6CENSUS: DATE:
03/04/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA arrived and was greeted and granted entry by Administrator Dennis Bui and Licensee Kevin Dinh. An application to operate a Residential Care Facility (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by Community Care Licensing (CCL) on 12/4/2023.

The facility is the first floor of a two-story home. The second floor is not included in the facility's fire clearance and residents do not have access to the second floor. The facility houses three shared resident bedrooms, two bathrooms, living room, dining room, kitchen, detached two car garage and backyard with pool. LPA did not observe any obstructions blocking the exit gates or obstacles or hazards in the backyard.

Client Bedrooms have all the necessary requirements including bed, chair, storage for clothing and ample lighting. LPA observed all windows were screened.

All bathrooms have working plumbing and designated hand washing posters. Hot water heater is set to 115 degrees Fahrenheit.

Pool: The facility has a pool in the backyard. The pool is enclosed on its two shorter sides by a brick wall. It's two longer sides are enclosed by a pool patio area and brick wall on one side and an iron fence on the side closer to the house. The iron fence is five feet high with four inches of space between each vertical bar and four inches of space between the bottom of the fence and the ground. The iron fence has a door that opens away from the pool. It is self-latching.

LPA observed the fire extinguisher to be fully charged as indicated by the arrow pointing in the green zone. LPA observed a receipt for the fire extinguisher which indicates the it was purchased on 1/6/2024
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ROCKVIEW RESIDENTIAL CARE
FACILITY NUMBER: 306006467
VISIT DATE: 03/04/2024
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LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and are stored and locked in the kitchen and garage.

Medications, First-Aid Kit, Resident & Staff Files will be locked in cabinets in the kitchen and hallway.

The fire clearance was approved by a fire inspector of Orange County Fire Authority on 1/11/2024.

A supply of extra linens is stored in the closet under the stairs.

Emergency Phone Numbers, Exit Plan, PUB475 are all posted and available for review.

Smoke and Carbon Monoxide detectors are stationed throughout the home and are wired together. Both types of detectors were tested and noted as operational.

Operational appliances include a gas stove, oven, refrigerator, dishwasher, microwave, washing machine and dryer.

LPA reviewed and provided Licensee with the Component III presentation to offer information and resources regarding maintaining facility compliance.

The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC809 (FAS) - (06/04)
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