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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006630
Report Date: 03/17/2025
Date Signed: 03/17/2025 03:10:59 PM

Document Has Been Signed on 03/17/2025 03:10 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 PLACE LIKE HOME 2FACILITY NUMBER:
306006630
ADMINISTRATOR/
DIRECTOR:		BEN, SHEILAFACILITY TYPE:
740
ADDRESS:14702 KATHY STTELEPHONE:
(714) 609-2303
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 6CENSUS: 0DATE:
03/17/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Maria Avila, Sheila BenTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Licensee (LE) Maria Avila and Administrator (AD) Sheila Ben.

An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on September 14, 2024, for a total capacity of six non-ambulatory clients, in which one maybe bedridden. The fire clearance was approved by a fire inspector from the Orange County Fire Authority on September 26, 2024.

The facility is a one-story home with five bedrooms, three bathrooms, a living room, a kitchen, a dining area, and attached two car garage. There are two side exit gates on both sides of the house that are self-latching and unlocked. There is a shaded seating area for clients in the backyard and LPA did not observe any obstacles or hazards. There are activities such as games and puzzles for residents to play and participate in.

LPA observed Administrator certificate, Facility sketch and Emergency Disaster Plan in the facility mounted on the wall in the kitchen and living room area. The See Something, Say Something poster (PUB 475), Long Term Care Ombudsman poster, and Personal Rights were posted up on the wall by the dining area.

Resident bedrooms had the required furnishings. Bedrooms with sliding doors had working door alarms. LPA observed all beds had linens and blankets. Smoke detectors and carbon monoxide detectors tested operational. Hot water temperatures in the bathrooms measured around 107.7 Fahrenheit degrees. Toxins were secured and locked underneath the kitchen sink along with the sharps stored in a separate plastic container. All additional toxic chemicals, cleaning solutions, and disinfectants are inaccessible to clients and will be stored in the garage.

Medications will be stored in a locked cabinet in the kitchen with resident files. The first aid kit with all the required elements and first aid guidebook was observed in the dining area on top of a cabinet table. Records



Prelicensing Report continuation on LIC809-C
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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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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 PLACE LIKE HOME 2
FACILITY NUMBER: 306006630
VISIT DATE: 03/17/2025
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will also be stored alongside with medication in the cabinet. Licensee has mention she might purchase a separate cabinet to store resident and facility files. A phone is in the kitchen for clients to use.

A supply of two day/seven-day of perishable and non-perishable food was observed. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. Emergency food and water and additional supplies were observed to be well stocked in the kitchen pantry and garage. There is a laptop in the kitchen for the residents to use. The fire extinguisher is in the dining area and is fully charged and serviced on September 6, 2024.

The facility is ready to be licensed. LPA conducted the Component Three Orientation with Licensee Maria Avila and Administrator Sheila Ben. Licensee 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 this report was provided to the Licensee and Administrator.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC809 (FAS) - (06/04)
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