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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000607
Report Date: 08/24/2022
Date Signed: 08/24/2022 11:22:54 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/24/2022 11:22 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:LULLABY LANE GUEST HOME IFACILITY NUMBER:
306000607
ADMINISTRATOR:LORETA DELEONFACILITY TYPE:
735
ADDRESS:1955 W. LULLABY LANETELEPHONE:
(714) 517-0916
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 5DATE:
08/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Maricel DeLeon, Loreta DeLeonTIME COMPLETED:
11:22 AM
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On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted, and granted entry into the facility by Licensee Maricel DeLeon. LPA Quiroz met with Licensee Maricel DeLeon and Administrator Loreta DeLeon and explained the nature of the visit. This facility is licensed to provide services to 6 Ambulatory Clients. Administrator Loreta DeLeon has an Administrator Certificate with expiration date of 06/29/2024.

On or about 10:38 am, LPA Quiroz along with (AD) Loreta DeLeon toured the inside and outside of facility. There are five clients in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz interacted with one of five clients in care. (AD) Loreta DeLeon indicated four of five clients are currently at Day Program. Client's bedrooms and facility temperature recorded to be between 77-78 degrees Fahrenheit.

During today's visit, one of five clients present at facility appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected clients’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. Facility is taking temperatures daily and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies in hallway near kitchen area. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs and shad area for clients and visitors enjoyment in the back yard area.

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

This report was reviewed with Licensee Maricel DeLeon and Administrator Loreta DeLeon during today's visit, and a copy of this report and LIC 811- Confidential Names were provided at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2022
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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