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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000578
Report Date: 04/13/2022
Date Signed: 04/13/2022 11:56:35 AM

Document Has Been Signed on 04/13/2022 11:56 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:FORDVIEW HOMEFACILITY NUMBER:
306000578
ADMINISTRATOR:MARITES T. DE VERAFACILITY TYPE:
735
ADDRESS:24372 FORDVIEW STREETTELEPHONE:
(949) 916-7233
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 6CENSUS: 3DATE:
04/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marites De Vera, AdministratorTIME COMPLETED:
12:30 PM
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This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Ruth Martinez to follow up on an incident reported to community Care Licensing cross reported by Regional Center. LPA arrived at the facility was greeted and granted entry by caregiver. LPA met with Marites De Vera, Administrator and explained the nature of the visit.

During today’s visit, LPA completed a review of P&I records for clients, interviewed Administrator and completed a review of client records.

On March 24, 2022 it was observed by Regional Center when reviewing P&I records for clients that there are ledger balances that may be of high balance. LPA verified the activity on the ledger and did not observe any unusual activity. LPA observed that C1 had a higher balance than rest of clients. LPA in review of records observed that C1 records have been at a high balance since the beginning of this year. LPA was informed by Administrator that due to the pandemic it has not been the same for the clients and them spending money. They do a lot of online shopping and at times don’t spend money and the balance can easily accumulate. However, LPA was informed that facility Administrator has developed a plan for client’s balance to lower. Clients are scheduled to have family outings and personal spending in the next month that will require clients to use more of their funds. LPA was advised that facility will take a more active approach to keep the balance of clients P&I records to a recommended balance.

LPA observed that the facility took immediate action on developing a plan to address the issue at hand with P&I funds. LPA did not observe any immediate and/or safety risks in or out of the facility.

Based on the observations made during today’s visit, no deficiencies were noted in the areas inspected today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrator and a copy of the LIC809 and LIC811 was provided and left at the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022
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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