A Home in Orange

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicants Manuel Rumion and Maria Jasmin Avila and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on September 2, 2025. The facility is to have a capacity of 6 Residents, (0) ambulatory, (5) non-ambulatory and (1) bedridden residents. Waiver granted for Hospice Care for (6). Facility phone number is (657) 223-6601. LPA observed the following. Structure: The facility is a one-story house with five Resident bedrooms, two full size bathrooms, a living room, a kitchen, a dining room, and an attached car garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall by the living room. There are two gates in the backyard, which both are self-closing and self-latching. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are five Resident bedrooms. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. CONTINUED ON LIC809-C... Bathrooms: All bathrooms are clean and have working plumbing. Hot water measured between 107.4 to 109.1 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen for each Resident was stored in the closet by the Resident's bedroom hallway. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menu posted and available. Monthly menu available and posted by the dining room. Food Service: There are no Residents living in the facility at this time. There is 7-day non-perishable food supply on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. Fire extinguishers were charged, mounted and one was located by the kitchen and one in the garage. Appliances: There is one gas burner stove which lights unassisted, one oven, one microwave, a refrigerator, a dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to Residents and will be stored in the backyard shed. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 107.4 to 109.1 degrees Fahrenheit. CONTINUED ON LIC809-C... Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in a cabinet next to the dining room. The first aid kit has all the required elements. Medications will be stored in locked cabinet next to laundry room. Resident & Staff Files: The Resident and Staff Records will be kept in a cabinet in the laundry room. Reading Material, Games, Equipment & Materials: The activities plan include playing board games, gardening, exercises, reading and going on walks. Fire clearance: Fire Clearance approved by a fire inspector of Orange Fire Department on September 24, 2025. Special conditions noted, "Fire clearance approved under the above noted conditions. 1 bedridden client and 1 nonambulatory client is approved for bedroom #5. Bedrooms 1, 2, 3, and 4 are approved for 1 nonambulatory client each." Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. LPA advised Applicant to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for inquiries and to submit incident reports. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB (Central Applications Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Dec 17, 2025

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Nov 21, 2025