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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006572
Report Date: 12/03/2024
Date Signed: 12/03/2024 10:59:50 AM

Document Has Been Signed on 12/03/2024 10:59 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:FLOWERS FAMILY CARE 2FACILITY NUMBER:
306006572
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, JONATHANFACILITY TYPE:
740
ADDRESS:2126 E MONROE AVETELEPHONE:
(714) 714-0851
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 6CENSUS: 0DATE:
12/03/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Jonathan MartinezTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 12/03/2024 Licensing Program Analyst's (LPA's) William Vanegas and Rose Ruppert made an announced visit for the purposes of pre-licensing. LPA's were greeted and granted entrance to the facility by administrator (AD) Jonathan Martinez. Upon entry we explained the nature of our visit and began a facility tour at 8:40 AM, LPA's observed the following.

This is a one story house with four resident bedrooms, one live in staff bedroom, this facility also has two bathrooms one staff/visitor bathroom, and one shared resident bathroom. Resident bathrooms were observed to have a water temperature of 87.4-127.3 degrees F. LPA's advised that water needs to be between 105-120 Degrees F. Facility has a fire place that was observed to not have a screen around it. Facility also has an attached two car garage with a washer and dryer inside the garage. Washer and dryer were tested to be operational and all laundry detergents were secured and locked. AD tested microwave, dishwasher, and gas stover burners, and they all tested operational. Facility's backyard was observed to have a seated shaded area, and has a small shed with no hazards in it. Exit routes were observed to be free of debris, and side doors are self latching and are not locked. LPA's observed a broken wood panel along the side fence. LPA's also observed a window with a crack on it in the dining room. LPA's observed a sliding door in resident room #2 to have difficulty being opened and advised AD, that it needs to be fixed for the safety of the resident's.

All resident bedrooms were observed to have the required furnishings such as lamps, chest drawer's, beds, and linens that appeared to be in good condition meaning no tears, or strains. Resident bedrooms had enough closet and storage space. Resident rooms were observed to not have any screens on the windows. Resident bathroom was observed to be free of debris and mildew, bathrooms had slip-resistant matt and grab bars. Toilet was tested to be functional and in good repair. Fire alarms, and carbon monoxide detectors were tested and tested operational. AD demonstrated first aid kit to LPA's and it had all required items in it, however AD did not have a fist aid manual. Most required postings were posted on the wall of the main entrance including PUB475 however it was not the required size, personal rights, and right to resident council were posted, however the ombudsman posting was not posted.
CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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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: FLOWERS FAMILY CARE 2
FACILITY NUMBER: 306006572
VISIT DATE: 12/03/2024
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LPA's observed a locked cabinet that AD plans to store and secure medications, they are inaccessible to residents in care. LPA's observed a supply of 2 day perishable foods, and a 7 day supply of nonperishable food to be on hand. LPA's also observed a sufficient amount of emergency water for the resident's that will be in care. LPA's observed trash cans to not have tight fitting caps on them, and advised AD that they need trash cans with tight fitting caps on them.

LPA's observed board games, puzzles, and magazines that will be used for activities for the resident's who will be in care. LPA's noted enough space to participate in those activities indoors and outdoors.

LPA's notified AD that a follow up visit will need to be conducted in order to give them time to make the proper corrections in order to fall into compliance of Tittle 22. LPA's conducted an Exit interview and a copy of this report was provided to Licensee.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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