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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004010
Report Date: 05/13/2022
Date Signed: 05/13/2022 11:52:20 AM

Document Has Been Signed on 05/13/2022 11:52 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:LE-NA'RESIDENTAL CARE, INC.FACILITY NUMBER:
306004010
ADMINISTRATOR:LEONA SMITHFACILITY TYPE:
735
ADDRESS:5521 LOCKHAVEN DRIVETELEPHONE:
(714) 670-8397
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY: 6CENSUS: 6DATE:
05/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Jamie LeeTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit to conduct the required annual (mitigation) inspection. LPA was greeted and granted entry by Caregiver Tzarlles Leonardo after completing the Coronavirus 2019 (COVID-19) screening procedure. LPA stated the purpose of the visit and began the tour of the facility with Caregiver Leonardo. Administrator (Admin) Jamie Lee assisted the tour around 10:05 am.

The facility is a single level structure and licensed for 6 ambulatory clients. The facility offers a Level 4g service. As of today, there are 6 residents residing in the facility. LPA observed 2 staff on duty and 1 client resting in the living room. Caregiver Rowena Daileg stated that one client was visiting family and the four clients were at the day program. LPA observed the required department postings at the front door and all around the facility as well as hand washing signs in the restrooms. LPA observed all restrooms had ample soap/sanitizer and appeared clean. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Clients' bedrooms appeared clean and sanitary and had all required components. Smoke detectors, carbon monoxide, and auditory exit alarms were tested and operational. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medication and sharp items were inaccessible to the clients in care, however LPA observed that the laundry detergent was accessible as the clients would walk through the laundry room to access the second bathroom. The laundry detergent was removed during the visit. Fire extinguishers were mounted and charged. For the exterior portion, facility had patio furniture under a lattice with ample shading. LPA observed the emergency disaster and evacuation plans. Facility does have a back-up emergency food and water supply and has a 30 day supply of PPEs. LPA observed the First Aid Kit and manual.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2022
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 3
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: LE-NA'RESIDENTAL CARE, INC.
FACILITY NUMBER: 306004010
VISIT DATE: 05/13/2022
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LPA discussed Assembly Bill 665 that requires a licensee of any adult or senior 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.

LPA 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 Jamie Lee, and a copy of this report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
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