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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006581
Report Date: 11/25/2024
Date Signed: 11/25/2024 11:43:50 AM

Document Has Been Signed on 11/25/2024 11:43 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:COMPASSIONATE HOME CAREFACILITY NUMBER:
306006581
ADMINISTRATOR/
DIRECTOR:
MOHAMED, MUKTARFACILITY TYPE:
740
ADDRESS:1048 N HERMOSATELEPHONE:
(714) 908-6647
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: DATE:
11/25/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Rani AbbasTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst LPA Samer Haddadin conducted an announced visit for the purpose of completing a pre licensing inspection. LPA was greeted and granted entry by staff member, Rani Abbas. LPA and staff member began the tour and observed the following:

The facility is a one-story resident with a detached two-door garage. The facility has four bedrooms and three full bathrooms with no clients in care at the time of the visit.

LPA checked bedroom one and observed two separate beds; both beds had linens which; LPA checked the mattresses and found light brown stains on both. Room one had enough lighting and closet for storage. LPA did not observe any chairs. Bedroom two had to beds, light stand and closet for storage. LPA did not observe any chairs. LPA Checked bedroom three and observed that it had two beds; LPA observed both mattresses on the bed had saints; Room three had enough lighting and space for storage. Bedroom three did not have a chair. Bedroom four had two beds which also had two stained mattresses; it had enough lighting and storage and no chair.

Hard wired smoke detectors, carbon monoxide and audible exit alarms were tested to be operational. Fire extinguisher was observed with a tag without inspection date. Bathrooms were observed to be in good repair and provided with grab bars and hot water was measured at 115.6 degrees Fahrenheit. Facility did not meet the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements.

For the exterior portion, facility had outside a shaded area and no chairs; grounds were free of tripping hazards and ample space for activities. Facility has a 2-car garage and is kept locked and used for storage; the garage also had an operational washer and dryer. kitchen was in good repair with cleaning supplies and sharp items locked on cabinet. LPA observed a locked cabinet in hallway which will be used for meds.

Based on today’s visit and observation made at this facility, LPA will schedule a pre-licensing. An exit interview was conducted, and a copy of this report was provided to the staff member.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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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