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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006617
Report Date: 11/26/2024
Date Signed: 11/26/2024 04:32:36 PM

Document Has Been Signed on 11/26/2024 04:32 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:A TOUCH OF CARE AT MARYWOODFACILITY NUMBER:
306006617
ADMINISTRATOR/
DIRECTOR:		QUE, JUNDITHFACILITY TYPE:
740
ADDRESS:3130 E. MARYWOOD DRTELEPHONE:
(661) 269-6358
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 6CENSUS: 0DATE:
11/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Jundith QueTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 11/26/2024 at 1:00 PM Licensing Program Analyst's (LPA's) William Vanegas and Rose Ruppert made an announced visit for the purposes of pre licensing. Upon arrival LPA's were greeted and granted entry to the facility by administrator (AD) Jundith Que and LPA's explained the purpose of the visit.

LPA's began the tour of the facility at 1:10PM and observed the following. This is a one story home with four resident restrooms, and three bathrooms one bathroom is a staff bathroom that will not be accessible to residents who will be in care, one bathroom is in the common area and one bathroom is a private bathroom that has a Jack and Jill entry way. The facility has two fire places that are screened and inaccessible. LPA's observed bathrooms to be clean, free of mildew, and debris. Faucets and toilets tested operational. Water in resident restrooms tested from 113.5 to 114.6 degree F. Carbon monoxide and smoke detectors all tested to be operational. LPA's observed that the fire extinguisher was fully charged, but did not have a tag on it because it was recently purchased.

LPA's observed Kitchen area is in clean and sanitary condition. LPA's observed a gas stove, microwave, and dishwashers, and they all tested operational. Sharps are secured and inaccessible to residents who will be in care. LPA's observed a location that medications will be stored in and it is locked and inaccessible to residents who will be in care. LPA's observed a first aid kit that had all the required equipment such as bandages, tweezers, scissors, and a thermometer. LPA's observed a washer and dryer that tested operational and all toxins are locked and secured.

LPA's observed four resident bedrooms and they have all the required furnishings such as a lamp, chair, chest drawers, and appropriate storage space for each individual. Beds have the appropriate linens and covers and they are in good repair, meaning no strains or rips. All windows were observed to be in good repair and having the required screens.
CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: A TOUCH OF CARE AT MARYWOOD
FACILITY NUMBER: 306006617
VISIT DATE: 11/26/2024
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LPA's observed all the required positings to be posted at the main entrance of the facility including the following. Resident rights, council of resident rights, PUB 475, visiting hours, ombudsmen, and disaster preparedness plan.

LPA's observed there to be a sufficient amount of planned activities for the residents. Administrator advised that they will have yoga classes in the morning, aerobics in the afternoon, and bingo in the evenings. They also stated that they will have karaoke, and card games.

LPA's toured the exterior of the facility and observed the following, all exit routes are free of any obstruction. A shaded seating area was observed. There is a jacuzzi that is in the backyard, however it is locked and has no water in it. Administrator advised that it is unplugged from the main power source, and there will be no water added to it. It has a top that is locked and not accessible to resident's who will be in care.

LPA's did not conduct the component three orientation as licensee currently owns and operates an additional facility. Licensee waived the component three orientation. Administrator was notified that the final application approval will be issued by the Centralized Application Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided to Licensee.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC809 (FAS) - (06/04)
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