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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004442
Report Date: 02/27/2024
Date Signed: 02/27/2024 12:05:18 PM

Document Has Been Signed on 02/27/2024 12:05 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
ORANGE COUNTY ASC, 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:
02/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lynette Dizon - AdministratorTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of
conducting a required annual inspection. LPA was greeted and granted entry into facility by Lead Staff Eduardo Manikad. Licensee Ludy Castro and Administrator Lynette Dizon were present for the inspection as well.

The facility is a one-story home with four client bedrooms, two bathrooms, kitchen, dining room, living room, staff room, backyard and detached 2-car garage. Facility appears clean, safe and sanitary. LPA noted five clients were away at day program. All client rooms had required elements, including bed, chair, closet space and ample lighting. Facility has extra linens for clients in the hallway closet. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured at 112.9 degrees Fahrenheit and 118.4 degrees Fahrenheit in the bathrooms. LPA observed facility has emergency food and water supply. Administrator stated the fire extinguisher is scheduled for service during the week of 2/26/2024. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in cabinets in the kitchen and the garage. Knives are locked up separate from toxic chemicals. Medication for each resident is kept locked in a cabinet in the kitchen. The backyard has a shaded sitting/lounging area. Exit gates are unlocked. LPA noted one of the exit gates drags along the concrete when it is opened. LPA advised facility to shorten the length of the wood on the gate so that it opens and closes seamlessly. LPA reviewed three client files and four staff files. LPA also reviewed medication for three clients and P&I for all six clients. Based on record review, LPA was unable to determine if emergency disaster drills took place at the facility in 2023. A deficiency is being issued. Based on P&I review, LPA determined one client's money was short by $10. The facility replaced the $10 missing from the client's P&I at the time of the inspection. A deficiency is being issued.

Two deficiencies and one Technical Advisory were issued based on today's inspection. An exit interview was conducted and a copy of this report and appeal rights was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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 02/27/2024 12:05 PM - It Cannot Be Edited


Created By: Dwayne L Mason On 02/27/2024 at 11:38 AM
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: D & D HOMES
FACILITY NUMBER: 306004442

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above due to the fact that the facility did not hold and/or document their quarterly drills in 2023. This poses a potential safety risk to persons in care
POC Due Date: 03/05/2024
Plan of Correction
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AD stated facility will hold a drill and document it in the drill log by the assigned POC due date of 3/5/2024. AD stated they will email LPA the completed drill documentation by the assigned POC due date.
Type B
Section Cited
CCR
80026(h)(1)
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on P&I review, the licensee did not comply with the section cited above in one client's P&I. This poses a potential personal rights risk to persons in care.
POC Due Date: 03/05/2024
Plan of Correction
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The Lead Staff corrected the error during the LPA's inspection. Lead Staff stated they will do an additional review of P&I after money is spent/withdrawn by the clients. LPA will review P&I again during POC visit which will occur after 3/5/2024.
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:Armando J Lucero
LICENSING EVALUATOR NAME:Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
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