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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006533
Report Date: 08/09/2024
Date Signed: 08/09/2024 01:04:27 PM

Document Has Been Signed on 08/09/2024 01:04 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:JUST LIKE YOU ARE HOME 1FACILITY NUMBER:
306006533
ADMINISTRATOR/
DIRECTOR:		REROMA STEVELYNFACILITY TYPE:
740
ADDRESS:518 N HAMLIN STREETTELEPHONE:
(714) 639-0528
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY: 6CENSUS: 5DATE:
08/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:42 AM
MET WITH:Stevelyn Reroma-Applicant, Alicia Lira-ApplicantTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA) Alvaro Ramirez, Jr. conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicant Stevlyn Reroma and toured the facility.

An application for Change of Ownership (CHOW) to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on January 30, 2024. The facility is to have a capacity of six, of which six can be nonambulatory and zero bedridden. Facility phone number 714-202-5044 LPA observed the following.

Structure:
The facility is a two level structure house with seven bedrooms, four full size bathrooms, a living room, a family room, a kitchen, a dining room, and an attached car garage. LPA did not observe an evacuation chair mounted next to the top of the stairwell. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entranceway. There is a backyard with an exit gate on each side of the house. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard.


Air/Heating:
Central air/heating system installed with a central panel to control entire house.

Resident Bedrooms:
There are six resident bedrooms. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets.


CONTINUED ON LIC809-C...
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
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 3
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: JUST LIKE YOU ARE HOME 1
FACILITY NUMBER: 306006533
VISIT DATE: 08/09/2024
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Bathrooms:
Bathrooms are clean and have working plumbing. Hot water measured between 107.4 and 109.0 degrees Fahrenheit. Sink faucet handle in bathroom # 6 is broken.

Linens & Hygiene Supplies:
A supply of extra linen for each resident was stored in a closet in the garage.

Emergency Phone Numbers, Exit Plan & Menu:
Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menu was posted and available. Monthly menu available and posted in the kitchen refrigerator.

Food Service:
There are five residents living in the facility at this time. A supply of 2-day perishable and 7-day of non-perishable food was observed and will be maintained on hand.

Smoke Detectors/Carbon Monoxide Detectors:
Smoke detectors/carbon monoxide detectors are hardwired and tested operational. There is a fire extinguisher mounted on the wall by the kitchen, one by the family room and one by second floor stairwell.

Appliances:
There is one, four gas burner stove which lights unassisted, one oven, one microwave, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational.

Toxins:
All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored in the garage.

Water Temperature:
Hot water was measured in all bathrooms. Hot water measured between 107.4 and 109.0 degrees Fahrenheit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
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: JUST LIKE YOU ARE HOME 1
FACILITY NUMBER: 306006533
VISIT DATE: 08/09/2024
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Medications, First-Aid Kit & Book:
The first aid kit and the first aid manual are stored in a cabinet by the dining room. The first aid kit has all the required elements. Medications will be stored in a locked cabinet by the kitchen..

Resident & Staff Files:
The Resident and Staff Records will be kept in a locked cabinet by the kitchen.

Reading Material, Games, Equipment & Materials:
Arts and craft and board games are stored in a cabinet in the family room. There is one large screen television in the living room.

Fire clearance:
Fire Clearance approved by a fire inspector of Orange Fire Department on May 23, 2024. Special conditions noted, "Fire Clearance approved under the above noted conditions."


Licensee to address the following corrections by 08/23/24:
  • Licensee to install an evacuation chair next to the stairwell.
  • Licensee to replace the missing bathroom sink faucet handle in bedroom #6.
  • Licensee to repair the chipped/black discoloration areas in kitchen, behind the entrance door and in bedroom #1 and #2.
  • Licensee to clean the yellow discoloration/rust in the kitchen sink.
  • Licensee to repair the chipped baseboards throughout the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
LIC809 (FAS) - (06/04)
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