<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006517
Report Date: 12/16/2024
Date Signed: 12/16/2024 05:14:17 PM

Document Has Been Signed on 12/16/2024 05:14 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:TRINITY GUEST HOMES INCFACILITY NUMBER:
306006517
ADMINISTRATOR/
DIRECTOR:		LUMAUIG, KAYTEE-ANNEFACILITY TYPE:
740
ADDRESS:12642 SUSAN LNTELEPHONE:
(714) 643-9572
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 9CENSUS: 0DATE:
12/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:32 PM
MET WITH:Administrator Kaytee LumauigTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst's (LPA's) Jenifer Tirre and Eboni Bentley visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a two story residential home. LPA's along with Administrator Kaytee Lumauig toured facility at 2:45PM and observed the following:

Fire clearance approval was received on 10/03/2024. Structure: Facility is a two story, 9 bedroom home. 6 Resident rooms located on first floor and three bedrooms located on second floor for licensee live in staff. Facility has three full and one half bathroom. Facility has attached garage. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. Bathrooms: All resident bathrooms have a working toilet, wash basin, and shower as well as non-skid mats in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Facility has two fire extinguishers. Fire extinguisher's are mounted and charged. Facility has audible alarms on all sliding/exit doors. Appliances: Electric Stove and refrigerator are operational. Toxins: LPA's observed cleaning supplies and toxins secured in laundry storage area as well as under kitchen sink.. Water Temperature: Tested and recorded between 111.7 to 116.4 degrees Fahrenheit in facility bathrooms. Reading Material Games, and Equipment:

facility does exercises, puzzles and games. Facility has a tablet with internet for Resident use. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility with first aid manual. Facility has a secured location for medications and facility files. Facility has department postings in entry way.

CONTINUED 809C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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: TRINITY GUEST HOMES INC
FACILITY NUMBER: 306006517
VISIT DATE: 12/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
. Backyard: LPA observed the facility perimeter is secured by wall with gates on both sides of facility as required. LPA observed shaded outdoor seating. Facility has a pool with secured gate.

Administrator's Certificate observed for Kaytee Anne Lumauig expiring November 30, 2026



Component III Orientation was not completed during this pre-licensing visit and will be completed at follow up visit.

Licensee to address the following corrections by January 6, 2024:
· Licensee to remove expired canned goods and condiments from kitchen pantry & fridge
· Licensee to provide grab bars on side of restroom toilets ( restroom 1 and restroom 2)
· cleaning supplies to be secured in upstairs staff common area
· Licensee to provide additional emergency food for all residents and staff
· outside gates need repair of springs to have gates latch on both sides of house
· outside patio area needs upkeep near fruit trees
· Facility capacity needs to be corrected from 9 to 6

The facility is not ready to be licensed. Licensee to contact LPA when corrections are complete.
An exit interview was conducted with Administrator Lumauig and a copy of this report was left at the facility.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2