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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
300605586
Report Date:
06/26/2024
Date Signed:
06/26/2024 10:24:38 AM
Document Has Been Signed on
06/26/2024 10:24 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:
PEOPLE IN PROGRESS-JEFFERSON
FACILITY NUMBER:
300605586
ADMINISTRATOR/
DIRECTOR:
DANE SYNDER
FACILITY TYPE:
735
ADDRESS:
5372 JEFFERSON RD.
TELEPHONE:
(714) 646-9596
CITY:
YORBA LINDA
STATE:
CA
ZIP CODE:
92886
CAPACITY:
6
CENSUS:
3
DATE:
06/26/2024
TYPE OF VISIT:
Case Management - Health Checks
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:
Direct Care Staff Shawn Malone
TIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Jenifer Tirre is conducting this visit for the purpose of conducting a health and safety check. LPA arrived at the facility was greeted and granted entry to the facility by direct care staff and explained the nature of the visit.
The facility has three clients in care. Upon entry LPA observed there were one client relaxing in the living room and two clients relaxing inside bedrooms watching TV. During the visit LPA took a tour of the inside of the physical plant of the facility. LPA inspected food supply; adequate amount was observed to be within regulations. The facility has a two-day supply of perishables and seven-day supply of non-perishables food available as required by regulations. Facility has one extra refrigerators in the garage with food supply. LPA observed hallways and walkways were free of obstruction. LPA observed a locked storage with client’s medication. LPA reviewed medication and it was observed all medication was labeled and meet regulation requirements. LPA toured the outside of the facility and observed there is a covered patio with shaded seating area for the clients enjoyment.
LPA interviewed staff and reviewed client records. LPA reviewed three(3) client records. All the required documentation was present and current in client’s files reviewed. LPA reviewed and verified Direct Care Staff has a criminal record clearance and is associated to this location.
Exit interview was conduced with staff and this report was reviewed with facility representative. A copy of this report along with confidential names list was provided to the facility.
SUPERVISORS NAME
:
Lourdes Montoya
LICENSING EVALUATOR NAME
:
Jenifer Tirre
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/26/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/26/2024
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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