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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004442
Report Date: 03/10/2022
Date Signed: 03/10/2022 03:16:04 PM

Document Has Been Signed on 03/10/2022 03:16 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:D & D HOMESFACILITY NUMBER:
306004442
ADMINISTRATOR:DIZON, DEXTER R.FACILITY TYPE:
735
ADDRESS:1922 E.WILLOW STREETTELEPHONE:
(714) 860-4445
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 6CENSUS: 6DATE:
03/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Eduardo MankiadTIME COMPLETED:
03:25 PM
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Licensing Program Analysts (LPAs) Jerome Haley and Kevin Saborit- Guasch arrived unannounced to the facility on this day at 2:40 PM for the purpose of following up on the Order for Immediate Exclusion. LPAs met with facility Staff (S1) Eduardo Manikad and informed him of the purpose of the visit. S1 contacted Administrator (AD) Dexter Dizon via telephone. LPA Haley spoke to AD Dizon over the phone and explained the reason for the visit.

AD Dizon stated he is aware of the Department of Social Services "LETTER OF IMMEDIATE EXCLUSION" regarding Jhon Garcia. AD Dizon stated at this time Jhon Garcia is no longer employed at the facility.

Three staff were present for the visit today and all were associated with the facility. Currently Jhon Garcia is still associated and present on the staff roster. LPA Haley consulted with AD Dizon over the phone and explained the importance of having Jhon Garcia disassociated immediately. Before the visit was over AD Dizon called back to the facility and spoke to LPA Haley and stated that he has just obtained a temporary access code for guardian to disassociate Jhon Garcia from the facility. AD stated he will inform LPA as soon as disassociation is complete.

An exit interview conducted with S1, and a copy of this report was provided to the facility at the time of the visit.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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