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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003778
Report Date: 07/21/2025
Date Signed: 07/21/2025 03:45:05 PM

Document Has Been Signed on 07/21/2025 03:45 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:D & D HOMESFACILITY NUMBER:
306003778
ADMINISTRATOR/
DIRECTOR:		LEILANI MAE DAGDAGFACILITY TYPE:
735
ADDRESS:10202 DALE AVETELEPHONE:
(714) 827-2737
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY: 5CENSUS: 2DATE:
07/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Leilani DagdadTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Administrators (AD) Leilani Dagdag was notified and arrived a few minutes later and was present for the remainder of the visit.

Structure: The facility is a single level structure and licensed for five ambulatory clients. As of today, facility had four clients, two clients were present during the visit and the other two clients were at their day program. There’s a total of 5 bedrooms for the clients, with one room is currently vacant, and two restrooms. There’s a living room space and a dining space. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Non-skid mats were observed. Hot water measured in between 105 – 105.9 degrees F. Kitchen: 2 of 4 burners were operational on the gas stove. AD Dagdag showed me a receipt for a new stove that’s scheduled to arrive July 23, 2025. Sharps are kept locked in a locked cabinet below the counter near the sink. No cleaning chemicals are stored in the kitchen. Below the sink is a supply of pots and pans. Food Service: LPA Haley observed a supply of perishable and non-perishable food items that meet regulation requirements. Nonperishable food items are stored in the pantry area closet right outside the kitchen in the hallway.



Client & Staff Files: Client and staff files are located in a locked closet in the hallway. The locked closet also contained the clients’ P&I funds.
File Review: 3 of 4 client files were reviewed during the visit, and three staff files were reviewed.

Continued on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jerome Haley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: D & D HOMES
FACILITY NUMBER: 306003778
VISIT DATE: 07/21/2025
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Medications/First-Aid Kit: Client medications are stored in a locked medication cabinet right outside the kitchen. There was a first aid kit with all the requirements.
Medication Review: 3 of 4 client medications were reviewed during the visit,

Linens & Hygiene Supplies: Clients had a hygiene caddy in their closet, and in one of the bathrooms there is a locked cabinet used to store additional hygiene supplies.

Garage Area: The garage is clean and organized. The walkways were free of obstruction. A washer and dryer was observed. Cleaning chemicals and detergents are stored in the garage. Additional hygiene supplies are stored in the garage.

Backyard/Exterior: The backyard is clean and organized. Walkways are free of obstruction. There's a shed used to store recyclable items. Bodies of Water: None.

Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational.

Fire Extinguisher: Fire extinguishers was observed near the kitchen.

An emergency evacuation drill: Was conducted June 2, 2025. Evacuation drills are conducted quarterly.

Emergency Phone Numbers, House Rules, Exit Plan & Menu:


Several facility postings are posted at the entrance and readily available for review.

Additional Comments: The facility was not cited for the stove because a new store has been ordered and will be delivered in two days.

During the visit, 3 of 4 client files were reviewed, 3 or 4 client P& I funds were counted, and medications were reviewed for 3 of 4 clients. 3 staff files were reviewed and 3 staff were interviewed during the visit. Clients are nonverbal and were not interviewed.

No deficiencies are being cited, and no advisories will be issued as a result of today’s visit.


An exit interview was conducted, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jerome Haley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC809 (FAS) - (06/04)
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