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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002960
Report Date: 05/24/2022
Date Signed: 05/24/2022 04:26:05 PM

Document Has Been Signed on 05/24/2022 04:26 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:STANFORD HOMES-ANAHEIMFACILITY NUMBER:
306002960
ADMINISTRATOR:ALFREDO A. CHUFACILITY TYPE:
735
ADDRESS:328 N. VINE STREETTELEPHONE:
(714) 808-1600
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 15CENSUS: 10DATE:
05/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Albert ChuTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA Gutierrez met with Administrator (AD) Albert Chu and discussed the purpose of the inspection. During the inspection LPA Gutierrez and AD Chu conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

This is a single-story complex with nine bedrooms, and four bathrooms, with one bedroom being occupied by staff. During the inspection LPA observed two staff and ten residents in care. Residents were observed resting in their respective rooms and eating in the dining area. A 2-day supply of perishable and a 7-day supply of non-perishable food was observed during today’s visit. LPA observed the facility has a 30-day supply of (Personal Protective Equipment) PPE on hand.

LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, infection control training, PPE, staffing and staffing shortages.

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: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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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