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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002961
Report Date: 05/12/2023
Date Signed: 05/12/2023 02:47:57 PM

Document Has Been Signed on 05/12/2023 02:47 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:
05/12/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Eugene AboboTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Claudia Gutierrez and Dwayne Mason made an unannounced Plan Of Correction (POC) visit to the facility to follow up on a deficiency cited on 4/12/23. LPAs met with Administrator (AD) Eugenio Obobo and discussed the purpose of the visit.

During the required annual inspection conducted on 4/12/23, LPA Gutierrez observed two out of two windows missing in bedroom 15. The two openings where the windows should be, were and still are, covered with cardboard. Facility was cited under California Code of Regulations (CCR) 80087(a). The POC was for AD to follow-up with Fullerton City regarding replacement of windows as facility grounds are considered Historical and repairs have to be approved by City. AD was to provide LPA updates regarding window replacement via email by POC date 4/13/23. AD provided LPA with documentation from the city of Fullerton deeming the facility Historical and a receipt from Lowe’s dated 1/14/23 for window replacement and a return receipt, also from Lowe’s, dated 1/16/23. Windows were returned because they were made of vinyl and not wood. Per AD, windows must be made of wood in order to be approved by the city. During today’s visit, AD confirmed contractors are still being contacted and there is no timeline for when windows will be installed. A new deficiency is being cited per Title 22 Division 6 of the CCR.

LPAs conducted an exit interview 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: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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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Document Has Been Signed on 05/12/2023 02:47 PM - It Cannot Be Edited


Created By: Claudia Gutierrez On 05/12/2023 at 02:18 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: 05/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2023
Section Cited
CCR
80087(a)

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(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:
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AD will provide LPA with a receipt or invoice for window installation that includes date of when they will installed via email by POC date.
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Based on observation and interview, two out of two windows are missing in bedroom 15. The two openings where the windows should be, are covered with cardboard, which poses an immediate safety and personal rights risk to persons in care.
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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: 05/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023


LIC809 (FAS) - (06/04)
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