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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001212
Report Date: 08/23/2024
Date Signed: 08/23/2024 01:42:54 PM

Document Has Been Signed on 08/23/2024 01:42 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HCDD - DIANAFACILITY NUMBER:
306001212
ADMINISTRATOR/
DIRECTOR:
BOYD BRADSHAWFACILITY TYPE:
735
ADDRESS:2732 E. DIANA AVENUETELEPHONE:
(714) 666-8661
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 6CENSUS: 4DATE:
08/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:46 AM
MET WITH:Kim SouthernTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced visit to the facility for the purpose of conducting a Required - 1 Year inspection. Upon arrival, LPA met with Direct Support Professional (DSP) Felix Marquez. Administrator Kim Southern arrived shortly after. The Facility is licensed for a capacity of (6) ambulatory Clients. All 4 Clients were at Program during today's visit. Administrator certificate for Boyd Bradshaw expires on 12/23/2025. A tour of the physical plant was conducted inside and out with DSP Marquez. LPA observed no pools or bodies of water, all passageways were clear of obstructions and facility is maintained at a comfortable temperature. Backyard gate was observed to be unlocked and backyard well maintained. Smoke detectors and Carbon Monoxide detectors were observed to be in working condition. The last Disaster/Fire Drill was conducted on 07/04/24. Fire extinguishers were fully charged and mounted. LPA observed facility to have appropriate (2) day supply of perishable and (7) day supply of non-perishable food for Clients. Food appeared to be selected, prepared, and stored in a healthful manner. Knifes and sharps are kept locked and inaccessible to Clients. Overall kitchen was observed to be in clean condition. Cleaning supplies, detergent, and disinfectants were inaccessible. LPA observe facility to have emergency disaster supplies and complete First Aid kit supplies. Hot water temperature was within regulatory requirements. Bathrooms were clean and free of odor. LPA observed grab bars where appropriate and non-skid mats placed in shower. The Client's bedrooms are clean and appropriately furnished. LPA observed an adequate supply of extra linens and towels in hallway, observed a sufficient supply of hygiene items stored for Clients use. CPR/First Aid/CPI cards were current for staff. Medication was observed to be in a centrally stored location and medication reviewed appeared to have been dispensed accurately. LPA reviewed four Client files and one staff file. P & I money matched facility ledger.

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 sent to email on file.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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