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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004443
Report Date: 03/29/2022
Date Signed: 03/30/2022 07:18:53 AM

Document Has Been Signed on 03/30/2022 07:18 AM - 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:
306004443
ADMINISTRATOR:LUDY R CASTROFACILITY TYPE:
735
ADDRESS:1543 BEACON STREETTELEPHONE:
(714) 860-4463
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 4DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Don Enriquez, Lead StaffTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required 1 Year inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Martinez met with Lead staff Don Enriquez. Lead Staff Enriquez confirmed that there are currently no cases or exposures of COVID-19 within the facility. LPA was screened upon entry into the facility. COVID signs were posted in the facility and sanitization station is available as needed. There is no sign in procedure in place but one will be started. LPA Martinez observed that 2 of the 3 staff were wearing face masks. LPA explained to Lead Staff the importance of all staff wearing a face mask regardless of vaccination status. The facility has an approved Mitigation Plan and Emergency Disaster Plan on file. Facility is a Level 4. During today's visit, there were two clients present. Two clients were at Program. LPA conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available. The facility continues to monitor the clients regularly for any COVID-19 symptoms and/or change in condition. Facility has required Department postings. LPA observed toilet paper, hand wash soap and paper towels in each client's room for their use due to one client flushing items down the toilet. Hand sanitizer, soap, wipes and gloves were present and in sufficient supply. Facility has no shading area, nor table and chairs for outside visitation. Lead Enriquez stated client's leave with their family and don't visit at the facility. Administrator Certificate for Dexter Dizon expires on 07/13/2023. Facility has emergency food and water supply. Facility has a secured medication cabinet for Client medication and files. LPA consulted with staff regarding the importance of maintaining a 30 day supply of PPE on site. LPA advised the importance of mask wearing and hand washing for staff, visitors and client. Staff was reminded to review Department PINS in regards to Masking, Staff and Resident Testing, Visitation, Dining, Group Activities, Non-essential services, Outings, New Admissions and Entertainment. During walk through LPA observed toilet in client's bathroom has no toilet seat and kitchen cabinets have broken hinges and/or missing a door. Based on observations made during today’s inspection, the following deficiency is cited as per Title 22 of the California Code of Regulations. An exit interview was conducted, copy of report to be emailed.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
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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Document Has Been Signed on 03/30/2022 07:18 AM - It Cannot Be Edited


Created By: Lydia Martinez On 03/29/2022 at 10:21 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: 306004443

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above in that toilet in client's bathroom has no toilet seat and cabinets in kitchen have broken hinges and/or missing a door which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/05/2022
Plan of Correction
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Facility agreed to install a new toilet seat in client's bathroom by close of business day of 3/30/22 and to repair or replace hinges and doors on kitchen cabinets by 4/5/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Marina Stanic
LICENSING EVALUATOR NAME:Lydia Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022


LIC809 (FAS) - (06/04)
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