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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006581
Report Date: 12/02/2024
Date Signed: 12/02/2024 11:35:31 AM

Document Has Been Signed on 12/02/2024 11:35 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:
12/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:31 AM
MET WITH:RaniTIME VISIT/
INSPECTION COMPLETED:
12:10 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 and staff member, Abirahman. 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 a total of four bedrooms, three full bathrooms with no clients in care at the time of the visit.

LPA checked all four bedrooms and observed all to have the required furnishing: clean linens, chair night stand room for storage and enough lightning.

Hard wired smoke detectors, carbon monoxide and audible exit alarms were tested to be operational. Fire extinguisher was checked and observed it to be full charge with last inspection date of Dec.1st,2024. Bathrooms were observed to be in good repair and provided with grab bars and hot water was measured between 115.6-116.6 degrees Fahrenheit. Facility did meet the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements. Emergency Food and water was also available and stored in the garage

For the exterior portion, facility had a shaded area with char for residents ; 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 in cabinet. LPA observed a locked cabinet in hallway which will be used for meds.

Based on today’s visit , LPA completed the pre-licensing inspection and an exit interview was conducted and a copy of this report was given and left with staff members

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
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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