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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004442
Report Date: 03/11/2024
Date Signed: 03/11/2024 03:31:59 PM

Document Has Been Signed on 03/11/2024 03:31 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:
03/11/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator - Lynette DizonTIME COMPLETED:
03:47 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr arrived at the facility for the purpose of conducting a Plan of Corrections inspection. LPA arrived and was greeted and granted entry by DSP Pedro Canoza. LPA stated the purpose of the inspection. Administrator Lynette Dizon arrived at the facility at approximately 10 am.

LPA is following up on deficiencies issued at an annual inspection conducted on 2/27/24. The facility received a deficiency for being unable to present proof of disaster drills conducted in 2023. The facility also received a deficiency for having an inaccuracy in the P&I.

Based on record review, LPA determined the facility conducted a fire drill on 2/29/24. LPA also noted that the facility located their disaster drill logs for 2023.

AD Lynette Dizon stated to LPA that AD Eduardo Manikad has the only key to access the P&I and is unreachable until 2:00pm. LPA stated to AD Lynette Dizon that another staff member needs to have a key to access the P&I if the Administrator is unreachable. The LPA left the facility at approximately 10:20 am.

LPA returned to the facility at approximately 2:45 pm.

LPA reviewed P&I with AD. LPA found no errors in the P&I.

Based on today's inspection, LPA determined the facility has fulfilled the plan of corrections assigned on 2/27/24. An exit interview was conducted and a copy of this report and POC Clear Letters were provided.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2024
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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