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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001425
Report Date: 02/24/2023
Date Signed: 02/24/2023 10:08:07 AM

Document Has Been Signed on 02/24/2023 10:08 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
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LE-NA' RESIDENTIAL INC.FACILITY NUMBER:
306001425
ADMINISTRATOR:LEONA LYNN SMITHFACILITY TYPE:
735
ADDRESS:19782 RANGER LANETELEPHONE:
(714) 963-9847
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 4CENSUS: 4DATE:
02/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Sheba Morris, House ManagerTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by staff. LPA met with Sheba Morris, House Manager and explained the nature of the visit.

LPA Martinez accompanied by house manager began the tour of the inside and outside of the facility. There are four clients in care and no active covid cases in the facility. Upon entry LPA observed clients having breakfast. All clients appeared to be clean and well taken care of. There is a sign-in procedure in place with temperature checks. LPA observed required department postings, covid posting, and hand washing signs in the facility. Facility has a Mitigation Plan on file with CCLD. Facility has a required Emergency Disaster Plan in place. Facility has a secure location for medication and has a 30 day supply of medication for clients. There is a minimum of one week of non-perishables and two days of perishables foods available. Facility has an emergency food and water supply. The facility is equipped with sufficient hygiene, cleaning, and disinfecting supplies. During the visit LPA observed staff cleaning and sanitizing the facility. Personal protective equipment (PPE) supply is available. Bathrooms observed to have required components. LPA toured the client’s bedrooms, all bedrooms observed to have all required components. LPA toured the outside to the facility and observed shaded seating area for clients use.

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

This report was reviewed with the facility representative and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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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