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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006517
Report Date:
01/13/2025
Date Signed:
01/13/2025 08:13:44 AM
Document Has Been Signed on
01/13/2025 08:13 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:
TRINITY GUEST HOMES INC
FACILITY NUMBER:
306006517
ADMINISTRATOR/
DIRECTOR:
LUMAUIG, KAYTEE-ANNE
FACILITY TYPE:
740
ADDRESS:
12642 SUSAN LN
TELEPHONE:
(714) 643-9572
CITY:
GARDEN GROVE
STATE:
CA
ZIP CODE:
92841
CAPACITY:
6
CENSUS:
0
DATE:
01/13/2025
TYPE OF VISIT:
Prelicensing
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
07:00 AM
MET WITH:
Administrator/ Licensee Kaytee Lumauig
TIME VISIT/
INSPECTION COMPLETED:
08:45 AM
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Licensing Program Analyst (LPA) Jenifer Tirre made a announced inspection visit to follow up on corrections identified during Pre Licensing visit on 12/16/2024. LPA identified themselves and discussed the purpose of the visit with Licensee Kaytee Lumauig. An initial application to operate a Residential Care Facility For Elderly was submitted to CCL on 10/3/2024. There are 0 clients in care during today's visit. LPA observed the following:
At 7:10 AM LPA toured facility with Licensee. The following was observed:
·
Licensee removed expired canned goods from kitchen pantry & fridge
·
Licensee provided grab bars on side of restroom toilets ( restroom 1 and restroom 2)
·
cleaning supplies are secured in upstairs staff common area
·
Licensee provided additional emergency food
·
outside gate springs have been repaired and gates latch on both sides of house
·
outside patio area near fruit trees has been cleared of debris
·
Facility capacity was corrected from 9 to 6
Component III was conducted during visit. Facility is ready to be licensed. Exit interview conducted with Licensee and a copy of this report was provided to the facility.
SUPERVISORS NAME
:
Lourdes Montoya
LICENSING EVALUATOR NAME
:
Jenifer Tirre
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/13/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/13/2025
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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