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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002961
Report Date: 05/20/2022
Date Signed: 05/20/2022 04:07:53 PM

Document Has Been Signed on 05/20/2022 04:07 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 HOMESFACILITY NUMBER:
306002961
ADMINISTRATOR:EUGENIO C. ABOBOFACILITY TYPE:
735
ADDRESS:440 E.WILSHIRETELEPHONE:
(714) 526-7248
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 28CENSUS: 23DATE:
05/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administrator, Eugene AboboTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to conduct a annual visit. LPA introduced themselves and discussed the purpose of visit with Administrator Eugene Abobo.

During the visit LPA toured the facility. Facility is a 15 bedroom and 6 bathroom single story home. There are 23 Clients in care. LPA observed proper covid signage at front entrance of facility as well as sanitization station. Facility has required Department postings. LPA observed Emergency Disaster plan and observed copy of Administrators Certificate expiring 9/25/2023. LPA toured all clients rooms, rooms contained required furniture such as beds, dressers, night stands and lighting. All restrooms observed contained working wash basin, toilet, soap, toilet paper and paper towels provided before use. LPA observed an outside visitation area with ample shading. Clients were observed relaxing in the Living room and patio areas. Facility has audible alarm system with sprinkler system attached .Bay Alarm Company document was provided confirming last fire inspection was completed on May 18, 2022. Facility has 6 fire extinguishers all mounted and fully charged. Facility has 2 large activity rooms filled with games and books. Facility has ample emergency food and water supply. Facility has a secured location for client medication and files. During today's visit LPA reviewed 23 clients medications. Clients have 30 day supply of medications. LPA reviewed 10 clients files. Each file reviewed had updated Emergency Contact information and Physician's reports. Facility had ample supply of PPE. Facility has a secured location for toxins and hazardous materials.


No deficiencies noted during todays visit. An exit interview was conducted with Administrator Eugene Abobo and a copy of this report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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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