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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607404
Report Date: 05/30/2023
Date Signed: 05/30/2023 12:05:07 PM

Document Has Been Signed on 05/30/2023 12:05 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LAURENCE RESIDENTIAL CAREFACILITY NUMBER:
300607404
ADMINISTRATOR:LAURENCE, VERNELLFACILITY TYPE:
735
ADDRESS:3722 S. ROSS ST.TELEPHONE:
(714) 662-7771
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 6CENSUS: 3DATE:
05/30/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Facility Administrator - Vernell LaurenceTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 05/22/2022. LPA De Perio explained reason for visit, was greeted and granted entry by facility administrator (AD) Vernell Laurence.

On 05/22/22 facility failed to ensure that medications were locked. Deficiency cited under Title 22 Regulation 80075(k)(1) pertaining to Health Related Services has been CLEARED. For this visit, LPA De Perio conducted a tour of the facility and observed that licensee has ensured all medications/vitamins are locked and inaccessible to clients in care. Licensee has complied with the terms of the POC.

On 5/22/22, facility failed to ensure that the facility was kept clean, safe and sanitary. Deficiency cited under Title 22 Regulation 80087(a) pertaining to Buildings and Grounds has been CLEARED. For this visit, LPA De Perio conducted a tour of the facility and observed that licensee has cleaned the bathrooms of the clients, and is now sanitary. Licensee has complied with the terms of the POC.

An exit interview was conducted with AD Laurence. A copy of this report was provided and explained.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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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