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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004443
Report Date: 03/08/2024
Date Signed: 03/08/2024 01:36:30 PM

Document Has Been Signed on 03/08/2024 01:36 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 RO, 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: 3DATE:
03/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lynette Dizon, AdministratorTIME COMPLETED:
01:45 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit for the purpose of conducting a Required Annual Inspection. LPA was greeted and granted entry by caregiving staff after introducing himself and stating the purpose of the visit. Administrator Lynette Dizon was contacted by phone and arrived later to assist with the visit.

During the inspection, LPA and administrator conducted a tour of the physical plant and observed the following: The facility is a one-level home with four client bedrooms, three staff rooms (two of which are locked) and two bathrooms. All client bedrooms have the required furnishings. LPA observed all beds had linens and blankets and an adequate additional supply is present. The backyard has a shaded sitting area and the route of egress is free of clutter and obstructions. There are currently three clients in care at the facility. Bathrooms faucets and toilets were operational. Water temperature is noted to be in the appropriate temperature range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with up-to-date maintenance. Sharps were observed locked in a drawer in the kitchen. LPA observed cleaning supplies to be stored in a locked cabinet under the kitchen sink. The medication central storage was observed to be locked. LPA reviewed the medication on hand. The staff member in charge of accessing the Personal and Incidental Funds was off-duty during the visit. As a result P&I funds will need to be reviewed at a later time. LPA reviewed three client files and six staff files before conducting one staff interview.

Based on the observations made during today’s inspection, no deficiencies are being cited along with two Technical Violation and two Technical Assistance Advisory Notes per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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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