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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002961
Report Date: 04/12/2023
Date Signed: 04/12/2023 02:56:22 PM

Document Has Been Signed on 04/12/2023 02:56 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:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Eugenio AboboTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA met with Administrator (AD) Eugenio Obobo and discussed the purpose of the inspection. During the inspection LPA and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, storage room, laundry room, kitchen, garage and observed the following:

This is a single-story complex with 16 client bedrooms, seven bathrooms, and two staff offices. All client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. LPA observed two out of two windows in bedroom 15 were missing and boarded up with cardboard; a Deficiency was cited on today’s date. The courtyard has a shaded sitting area. Bathroom faucets were operational and water temperature tested at 114.4 F degrees. Three out of seven bathroom toilets were observed to be containing body waste; a deficiency was cited on this date.

LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted at the entrance of the facility. Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguishers were observed to be fully charged. LPA reviewed facility fire drill log that indicate the last fire drill was on 3/17/23. Kitchen refrigerator and six burner gas stove tested operable. Freezer located in activity room tested above regulation temperature and a red fluid was observed to be coming from a bag containing meat; a Deficiency was cited on this date. Sharps were observed locked in the kitchen. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients. Medication was observed to be locked. The first aid kit has all the required elements. LPA reviewed three client files and three staff files. LPA interviewed three clients and two staff.

Based on the observations made during today’s inspection, three 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 and appeal rights was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
Document Has Been Signed on 04/12/2023 02:56 PM - It Cannot Be Edited


Created By: Claudia Gutierrez On 04/12/2023 at 01:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: STANFORD HOMES
FACILITY NUMBER: 306002961

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
85095.5(a)(2)(A)
Infection Control Requirements
A licensee shall ensure that infection control practices are maintained as follows:  (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products.  These activities shall be completed, at a minimum, as follows:  (A) Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary.  These surfaces shall also be disinfected when these surfaces are contaminated or visibly soiled. 

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed and obtained a picture of three out of seven bathroom toilets containing body waste which poses an immediate health risk to persons in care.
POC Due Date: 04/13/2023
Plan of Correction
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AD stated they would schedule staff to check all facility bathrooms on an hourly bases to ensure toilets are clean and disinfected. AD will provide LPA with a copy of bathroom checks schedule via email by POC date.
Type A
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in bedroom 15, two out of two windows are missing, and have been boarded up with carboard which poses an immediate safety and personal rights risk to persons in care.
POC Due Date: 04/13/2023
Plan of Correction
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AD stated they would follow-up with Fullerton City regarding replacement of windows as facility grounds are considered "Historical" and repairs have to be approved by City. AD will provide LPA updates regarding window replacement via email by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 04/12/2023 02:56 PM - It Cannot Be Edited


Created By: Claudia Gutierrez On 04/12/2023 at 01:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: STANFORD HOMES
FACILITY NUMBER: 306002961

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
85076(d)(4)
Food Service
(4) Freezers and refrigerators shall be kept clean, and food storage shall permit the air circulation necessary to maintain the temperatures specified in (2) and (3) above.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in one out of three refrigerators, LPA observed the base to be rusted with additonal brown discoloration around it. LPA tested one out of one freezers at 20.8 degrees Fahreneheit above regulation and observed red fluid coming from a bag containing meat which poses an immediate health risk to persons in care.
POC Due Date: 04/12/2023
Plan of Correction
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AD stated they would schedule staff to check all facility freezers and refridgerators on a daily bases to ensure cleanliness and regulation temperatures are met. AD will provide LPA with a copy of schedule via email by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023


LIC809 (FAS) - (06/04)
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