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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004178
Report Date: 03/18/2024
Date Signed: 03/18/2024 02:27:01 PM

Document Has Been Signed on 03/18/2024 02:27 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:GILBERT CARE HOME - LULLABYFACILITY NUMBER:
306004178
ADMINISTRATOR:ARNOLD C ANDALFACILITY TYPE:
735
ADDRESS:1512 W LULLABY LANETELEPHONE:
(714) 817-8983
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 4DATE:
03/18/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Arnald Andal - AdministratorTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced Case Management visit. LPA Haley was greeted and granted entry by staff and stated the purpose of the visit upon entry. Upon entering the facility, LPA Haley was led on a brief tour of the interior and exterior portions of the facility.

During the tour, LPA Haley observed an adequate food supply that meets regulation requirements. The hot water was measured at 112.2 degrees Fahrenheit in bathroom 1 and 113.0 degrees Fahrenheit in bathroom 2. Knives and sharp objects were locked in a drawer near the sink, and medications were locked in a closet near the from door.

A Health and Safety check was conducted on the 4 clients present during the visit. Clients were observed in the living room, in their room, and one client was in the backyard for a moment before going to his room.

No deficiencies are being cited today.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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