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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004174
Report Date: 03/17/2022
Date Signed: 03/17/2022 10:12:03 AM

Document Has Been Signed on 03/17/2022 10:12 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:DUELAS GUEST HOMEFACILITY NUMBER:
306004174
ADMINISTRATOR:LILIA DUELASFACILITY TYPE:
735
ADDRESS:10721 VICKERS DRIVETELEPHONE:
(714) 638-8219
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 6CENSUS: 4DATE:
03/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Idelma Santos, CaregiverTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA arrived at facility, was greeted and granted entry by Idelma Santos, caregiver after explaining the purpose of the visit. Caregiver called Administrator Lilia Duelas to notify her of the visit. AD Duelas was unable to assist with the visit as she was filling in for an absent staff member at another facility but Administrator Delfin Duelas arrived later.

At approximately 9:40am, LPA accompanied by caregiver toured the inside and outside of the facility. There are currently four (4) clients in care, three (3) of which are away at their respective day programs. Fourth client are observed to be relaxing in their bedroom. The four (4) bedrooms include all necessary components and sufficient quantity of linen is observed also. Facility appears to be clean, sanitary and free of odors in all areas inspected. Cleaning supplies, sharp instruments and toxic substances are stored in locked cabinets and drawers.

LPA observed the facility has COVID-19 Precautions posters and required department postings as well as hand washing signs. Facility has an adequate supply of PPE and emergency supplies. A LIC808 Mitigation has been submitted and approved on 05/11/2021.
LPA observed a sufficient supply of food and water. A 30-day supply of medication is stored and locked. LPA toured the outside of the facility. Outdoor furniture is present for the clients' enjoyment. Gates are easy to open and self-latching.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2022
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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