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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006533
Report Date: 08/30/2024
Date Signed: 08/30/2024 01:01:40 PM

Document Has Been Signed on 08/30/2024 01:01 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:
08/30/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Stevelyn Reroma-Applicant, Alicia Lira-ApplicantTIME VISIT/
INSPECTION COMPLETED:
01:16 PM
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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Samer Haddadin made an announced visit to the facility for purpose of conducting a pre-licensing inspection to follow up on corrections identified during visit on August 9, 2024. LPAs met with Applicant Alicia Lira 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.


At 12:10 LPA toured the facility and observed the following:
  • Licensee installed an evacuation chair next to the stairwell, Licensee replaced the missing bathroom sink faucet handle in bedroom #6, Licensee repaired the chipped/black discoloration areas in kitchen, behind the entrance door and in bedroom #1 and #2, Licensee cleaned the yellow discoloration in the kitchen sink, Licensee repaired the chipped baseboards throughout the facility.

All items noted from visit on August 9, 2024 have been addressed.

Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements.

The applicant has met all pre-licensing requirements. LPA will submit notification to CAB (Central Applications Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento.

Exit interview was conducted and a copy of this report was left with the applicant.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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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