<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003762
Report Date: 11/14/2022
Date Signed: 11/14/2022 04:28:42 PM

Document Has Been Signed on 11/14/2022 04:28 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:LAWANDA HOME IIFACILITY NUMBER:
306003762
ADMINISTRATOR:DANTE BENEDICTOFACILITY TYPE:
735
ADDRESS:1758 BRENTWOOD PLACE, W.TELEPHONE:
(657) 201-3148
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 5DATE:
11/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Dante Benedicto, AdministratorTIME COMPLETED:
04:28 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a Required Annual Inspection. LPA Quiroz was greeted and granted entry into the facility by Direct Support Professional 1 (DSP1) and met with Administrator Dante Benedicto.

This facility is a Level 3 Home and licensed to provide services to 6 Developmentally Disabled Non- Ambulatory clients. Administrator Dante Benedicto has an Administrator Certificate with expiration date of 7/15/2023.

On or about 2:42pm, LPA Quiroz reviewed 5 of 5 client records. On or about 3:13pm LPA Quiroz along with Administrator Dante Benedicto toured the inside and outside of the facility. There are five (5) clients in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz observed (2) two clients in their bedrooms resting and (2) clients in the living room area watching television. On or about 3:55pm, Client 5 arrived to facility from Day program. Five (5) of (5) five clients present in the facility appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected clients’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. Administrator Dante Benedicto indicated facility is taking temperatures three times daily; and documenting results.

LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food, water supply as well as PPE supplies. LPA Quiroz toured the outside of the facility and observed ample seating area with table and chairs for client's enjoyment in backyard area.

CONTINUED ON NEXT PAGE...

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: LAWANDA HOME II
FACILITY NUMBER: 306003762
VISIT DATE: 11/14/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONTINUED...The facility has completed the LIC 808 Mitigation plan dated 3/2/2021. The LIC 808 Mitigation Plan was approved by LPA Mikah Martinez on 4/21/2021.

During today's inspection visit, LPA Quiroz provided California Code of Regulations Title 22 consultation and COVID-19 guidelines. Administrator Benedicto indicated "All staff and clients are fully vaccinated for COVID-19, received first booster and scheduled for second booster already."

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrator Dante Benedicto, and a copy of this report and LIC 811-Confidential Names were provided at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2