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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004174
Report Date: 02/06/2024
Date Signed: 02/06/2024 04:21:33 PM

Document Has Been Signed on 02/06/2024 04:21 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: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:
02/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Lilia Duelas - Licensee/Administrator
Delfin Duelas - Administrator 		TIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jerome Haley conducted a case management visit regarding information discovered during the investigation into complaint control # 22-AS-20240206110137

During the complaint investigation mentioned above, it was discovered P&I funds were not accurate for Client 3 (C3) and Client 4 (C4) according to the P&I ledgers for both clients. When C3’s P&I funds were counted, the funds were $9.75 more than what was reported on the ledger. The ledger for C3 had a balance of $132.25. Staff 1 (S1) counted $142.00 in the presence of LPA Haley, Licensee Lilia Duelas, and Administrator Delfin Duelas.

P&I funds for C4 were also inaccurate. According to the P&I ledger C4 had a balance of $213.01 When C4’s P&I funds were counted, the funds were .69 cent less than what was reported on the ledger. Staff 1 (S1) counted $212.32 in the presence of LPA Haley, Licensee Lilia Duelas, and Administrator Delfin Duelas.

P&I funds were accurate for Client 1 (C1) and Client 2 (C2).

As a result of today’s Case Management visit, deficiencies will be cited.

An exit interview was conducted and a copy of this report, LIC809D, and appeal rights were provided.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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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Document Has Been Signed on 02/06/2024 04:21 PM - It Cannot Be Edited


Created By: Jerome Haley On 02/06/2024 at 03:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: DUELAS GUEST HOME
FACILITY NUMBER: 306004174

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
CCR
80026(h)(1)

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80026
Safeguards for Cash Resources, Personal Property, and Valuables of Residents
(h) Each licensee shall maintain accurate records of accounts of cash resources... entrusted to his/her care, including, but not limited to the following:

(1) Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting, with columns for income, disbursements and balance, for each client. Supporting receipts for purchases shall be filed in chronological order.
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Licensee Lilia Duelas and Administrator Delfin Duelas will read and review regulation 80026: Safeguards for Cash Resources, Personal Property, and Valuables, and send LPA Haley proof of acknowledgement and understanding and an outline of who will be responsible for maintaining accurate P&I Funds & ledgers. POC will be emailed to LPA Haley by the close of business Friday February 9, 2024 at 2:00PM.
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The above requirement has not been met as evidenced by inaccurate P&I funds for C3 and C4. The P&I funds did not reflect the balance on the P&I ledger for C3 or C4. S1 counted the funds while LPA Haley, Licensee Duelas, and Administrator Duelas observed the funds for C3 an C4 were not accurate according to the ledgers.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Luz Adams
LICENSING EVALUATOR NAME:Jerome Haley
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2024


LIC809 (FAS) - (06/04)
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