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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006556
Report Date: 12/09/2024
Date Signed: 12/09/2024 09:28:40 AM

Document Has Been Signed on 12/09/2024 09:28 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:SWEETWATER SENIOR CARE IIFACILITY NUMBER:
306006556
ADMINISTRATOR/
DIRECTOR:
MOOSANI, HASHIMFACILITY TYPE:
740
ADDRESS:4531 RANCHGROVE DR.TELEPHONE:
(949) 387-1422
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 6CENSUS: 1DATE:
12/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Hashim MoosaniTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Jerome Haley made an announced visit to conduct the second pre-licensing inspection. LPA Haley was greeted and granted entry by Applicant Hashim Moosani.

Upon entering the facility, LPA Haley toured the facility with the applicant and during a tour of the facility observed the following items have been corrected:


Corrections:
1) Repair or replace the fan/light on the stove/oven. – Fan and light on the stove are working properly after Applicant had the new equipment installed.
2) Remove/cover exposed wires – All exposed wires have been covered.
3) Clean all ceiling fans – Ceiling fans are clean and all dust has been removed.
4) Replace missing blinds in the living room sliding glass door – All missing blinds have been replaced, brand new blinds were observed on the sliding glass door.
5) Additional non-perishable food items – A supply of nonperishable items was observed in the kitchen.
6) Non-skid matts for showers – Both showers now have nonskid matts.

All corrections have been made and the facility is ready for licensure.

Component III was presented to applicant Hashim Moosani at the end of the inspection.

An exit interview was conducted and a copy of this report was provided to applicant Hashim Moosani.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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