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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006614
Report Date: 01/14/2025
Date Signed: 01/14/2025 02:21:40 PM

Document Has Been Signed on 01/14/2025 02:21 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:SIANI RESIDENTIAL CARE FACILITYFACILITY NUMBER:
306006614
ADMINISTRATOR/
DIRECTOR:
ESPANA, SHARONDAFACILITY TYPE:
740
ADDRESS:279 S LARKWOOD STREETTELEPHONE:
(909) 767-7030
CITY:ANAHEIMSTATE: CAZIP CODE:
92808
CAPACITY: 4CENSUS: DATE:
01/14/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:11 PM
MET WITH:Sharonda EspanaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Samer Haddadin made an announced visit to the facility today to conduct a Prelicensing visit. LPA was greeted and granted entry by Administrator (AD) Sharonda Espana.

The facility is a two-story home with 4 bedrooms and two restrooms located on the second floor, and one restroom downstairs. The facility has an approved fire clearance of four ambulatory residents, Facility had no residents in care at the time of visit.
During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature all three restrooms, and testing auditory devices on all exits. The hot water temperature measured between 112.4- and 108.6-degrees Fahrenheit, and all smoke detectors were operational. The fire extinguisher is charged with a proof of purchase of November 22nd, 2024.
LPA inspected the exterior of the facility, and the facility has a swimming pool that is a five-foot fence. Fencing does not obscure the view of the pool and has a self-latching gate.
LPA inspected the facility food supply and observed the facility retained seven days of non-perishable food on hand and will have two days of perishable items once there are residents in care. Knives and cleaning supplies are secured in a separate cabinet located in the kitchen.
LPA observed medication storage and a First Aid Kit with all the required components and medication storage is locked. LPA observed all required department posting hung by the entrance... LPA confirmed that administrator has a current administrator certificate which expires on January 2nd, 2027. LPA conducted Component III with Administrator.
The Administrator was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted, and a copy of the report was provided to Licensee.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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