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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001425
Report Date: 03/22/2024
Date Signed: 03/22/2024 04:46:23 PM

Document Has Been Signed on 03/22/2024 04:46 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: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:
03/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Assistant Administrator, Sheba MorrisTIME COMPLETED:
05:00 PM
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On 3/22/2024, Licensing Program Analyst's (LPA) Jenifer Tirre, Edward Kim and Licensing Program Manager (LPM) Lourdes Montoya conducted an unannounced required annual inspection visit using the CARE Inspection Tool. LPA was greeted by Assistant Administrator Sheba Morris and granted entry after stating the purpose of the visit with Assistant Administrator Morris

During inspection visit, LPA's observed Facility is a Level 4 Adult Residential Facility.During todays visit, LPA's observed four clients in care. During visit LPA's toured physical plant with Assistant Administrator.

The following were observed during visit:
Two fire extinguishers not mounted on walls, expired salad dressing, Dry cereal stored in garage near laundry products, two full bed rails with cushions for R1, Cameras in common areas, and trash cans obstructing outside pathway.

Due to time constraints inspection will be continued at a later date and deficiencies will be addressed.


An exit interview was conducted, and a copy of this report was provided to Facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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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