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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006486
Report Date: 05/31/2024
Date Signed: 05/31/2024 11:00:52 AM

Document Has Been Signed on 05/31/2024 11:00 AM - 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:GIADA'S HOUSEFACILITY NUMBER:
306006486
ADMINISTRATOR/
DIRECTOR:		DE VEAU, GUADALUPE D.FACILITY TYPE:
740
ADDRESS:24552 TROY STREETTELEPHONE:
(949) 367-5841
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 4CENSUS: 3DATE:
05/31/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Guadalupe De Veau, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility for the purpose of conducting a pre-licensing inspection. LPA was greeted and granted entry by Guadalupe De Veau, administrator.

An initial application for a license to operate as a Residential Care Facility for the Elderly was received by the Department on January 11, 2024 for a capacity of four non-ambulatory clients. This is a change of ownership with 3 residents already in care. The facility receives residents placed by the Regional Center of Orange County as aging clients with developmental disabilities.

LPA accompanied by administrator toured the physical plant. Facility is a one-level home with a frontyard, backyard and attached garage. There are four individual bedrooms. Each of the bedrooms include all necessary components of furnishing including a light, chair, storage space for personal items and a full-size bed as well as a supply of linen and bedsheets. There are three bathrooms on the premises, two of which are designated for use by the residents. Water temperature was measured to be within acceptable range. Common living spaces are present and a computer connected to the internet is present for the use of the clients in care. Facility is clean, sanitary and free of odors in all areas inspected.

Kitchen equipment is present and operating as required. Sharp items and cleaning supplies are confirmed to be secured. A sufficient supply of perishable and non-perishable food is present as required by Title 22 Regulations.

The centrally stored medication storage is located in a secure cupboard. The garage is also used for additional storage of food and activity items, along with emergency and back-up supplies. Staff and client records were reviewed and confirmed to include all necessary components.
CONTINUED ON FORM LIC809-D
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
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: GIADA'S HOUSE
FACILITY NUMBER: 306006486
VISIT DATE: 05/31/2024
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CONTINUED FROM FORM LIC809
The fire clearance has been obtained and provided to the Department before the pre-licensing visit. Combined smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional.

LPA and licensee toured the outside of the facility and observed it to be free of obstructions. A shaded area is present in the back of the house and is equipped with outdoor furniture for the enjoyment of residents and visitors. The perimeter gates present on both sides of the house are self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises.

No items of non-compliance were identified during today's visit. Component III was waived as the prospective licensee has already been acting as the current facility administrator for over a year. This report was reviewed with facility representative and a copy of this report was emailed to the prospective licensee before the conclusion of the visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
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