306000607-9-25-2023-22-AS-CGUZ-CVZSZ4-20230925141827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306000607
Report Date: 09/25/2023
Date Signed: 09/25/2023 02:19:00 PM

Document Has Been Signed on 09/25/2023 02:19 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:	LULLABY LANE GUEST HOME I		FACILITY NUMBER:	306000607
ADMINISTRATOR:	LORETA DELEON		FACILITY TYPE:	735
ADDRESS:	1955 W. LULLABY LANE		TELEPHONE:	(714) 517-0916
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY: 6		CENSUS: 5	DATE:	09/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Loreta DeLeon Marciel DeLeon		TIME COMPLETED:	02:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Administrator (AD) Loreta DeLeon; Co-Administrator Marciel DeLeon arrived shortly thereafter.

During the inspection LPA and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:

This is a two-story home; the first floor consists of three client bedrooms, three bathrooms, and two additional bedrooms are used for room and board. LPA confirmed room and board tenants have been background checked and are cleared to be present at the facility. The second story of the home is used as staff quarters. All client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. LPA observed all windows were screened. The back yard has a shaded sitting area. LPA observed one staff and no clients present, as all clients were away at day program. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 111.3-111.9 F degrees.

LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted at the entrance of the facility. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Stove burners, microwave, washer, and dryer were all inspected. Sharps were observed locked in a kitchen cabinet. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients. Medication was observed to be locked in a cabinet inside locked closet. LPA reviewed five client files and three staff files. Clients were not present to be interviewed. LPA interviewed two staff.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

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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