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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003778
Report Date: 06/09/2022
Date Signed: 06/09/2022 11:05:39 AM

Document Has Been Signed on 06/09/2022 11:05 AM - 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:D & D HOMESFACILITY NUMBER:
306003778
ADMINISTRATOR:LEILANI MAE DAGDAGFACILITY TYPE:
735
ADDRESS:10202 DALE AVETELEPHONE:
(714) 827-2737
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY: 5CENSUS: 5DATE:
06/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Leilani Mae DagdagTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced annual inspection focusing primarily on the Infection Control. LPA was greeted and granted entry by Administrator (Admin) Leilani Dagdag. LPA stated the purpose of the visit and entered the facility after completing the Coronavirus 2019 (COVID-19) screening procedure. Upon entry, LPA observed the screening station and sign in sheet for visitors. The required COVID-19 precautionary signs were posted on the front door and throughout the facility. The Administrator's Certificate for Leilani Dagdag expires on 11/3/2022.

The facility is a single level structure and licensed for five ambulatory clients. This facility offers a Level 4I service. As of today, facility had five clients. LPA observed one client preparing to leave to their day job, one client was at their day program, one client using the restroom, and the two clients were sleeping in their respective bedrooms.

At 9:58 am, LPA and Admin toured the interior and exterior portions of the facility. Facility appeared clean and sanitary in all observed areas. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke detectors, carbon monoxide, and auditory exit alarms tested operational. Per the LPA's request, facility will add four additional auditory alarms to the following areas due to Client #1 eloping: front door, door to the atrium, kitchen exit door, and the bedroom window for Client #1. Admin stated that the bedroom window of Client #1 does not have a window screen as the Client #1 removes it. LPA requested to add an auditory alarm on the window to prevent a future eloping incident. Restrooms observed to be in good repair; and provided with a grab bar and a non-skid floor mat. Facility had the required hand washing signs posted in all the restrooms. Hot water measured at 109.5 degrees Fahrenheit in Restroom #1 and 111.5 degrees Fahrenheit in Restroom #2. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies, and sharp items were inaccessible to the clients in care. The fire extinguisher was mounted and charged in the kitchen.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
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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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: D & D HOMES
FACILITY NUMBER: 306003778
VISIT DATE: 06/09/2022
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For the exterior portion, the facility had patio furniture under ample shading, shed for storing chairs, and grounds were free of tripping hazards. The side gates were self-closing and self-latching. LPA observed the emergency disaster and evacuation plans. Facility had sufficient emergency food and water supply. The First Aid Kit had all the required components, and the facility had sufficient PPE supplies stored in the locked medication cabinet.

LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. Facility provides an iPhone and laptop upon the client's request.

LPA Cho reviewed the approved COVID 19 mitigation plan of the facility. No deficiency cited in this review as per Title 22 Division 6 of the California Code of Regulations. An Advisory Note (LIC9102) was issued during the visit, and the licensee will follow-up with the corrections. An exit interview was conducted with Administrator Leilani Dagdag, and a copy of this report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
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