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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004443
Report Date: 01/16/2025
Date Signed: 01/16/2025 04:02:57 PM

Document Has Been Signed on 01/16/2025 04:02 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/
DIRECTOR:		LYNETTE DIZONFACILITY TYPE:
735
ADDRESS:1543 BEACON STREETTELEPHONE:
(714) 860-4463
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 3DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:02 AM
MET WITH:Flerida NatalicioTIME VISIT/
INSPECTION COMPLETED:
04:16 PM
NARRATIVE
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On January 16th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to conduct an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Direct Support Staff (DSP) Flerida Natalicio. LPA Vanegas explained the purpose of the visit and began to tour the facility and observed the following.

This is a one storied home with seven bedrooms four of which are client rooms and three of which are staff rooms. There are two bathrooms which are used for staff and clients and a two car attached garage. LPA Vanegas observed the kitchen area to be clean and free of debris. LPA Vanegas observed a gas stove, microwave, dishwasher and refrigerator that all tested operational and in good repair.

LPA Vanegas observed sharps to be locked and inaccessible to clients in care. LPA Vanegas observed a two day supply of perishable food and a seven day supply of non-perishable food. LPA Vanegas observed a sufficient amount of emergency water as well. LPA Vanegas observed fire extinguisher to be fully charged and up to date. LPA Vanegas observed smoke detectors and carbon monoxide detectors to be operational and in good repair.

LPA Vanegas observed client bedrooms to have all the required furnishings such as a bed, chair, night light, night stand, chest drawers, enough space to move freely in the respective room, enough storage space for personal belongs, and linens that are in good repair meaning no strains or tears. LPA Vanegas observed client restrooms to be clean and free of mildew and debris and had the required furnishings such as grab bars, slip resistant matts, and shower chair. Toilet and water faucets tested operational and water temperature tested from 117.8-118.2 degrees.

CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOMES
FACILITY NUMBER: 306004443
VISIT DATE: 01/16/2025
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LPA Vanegas toured the outside of the facility and observed the following. There is an outdoor shaded seating are. The outside of the facility is in clean and good repair. There is enough space to participate in outdoor activities, and no obstructions were observed along the emergency exit routes. Side doors are unlocked and self latching.

LPA Vanegas reviewed three client files, and four staff files all client filles consisted of the required documentation and one of four staff files did not contain T.B test result or required training a deficiency was cited on today's date. LPA Vanegas observed the facility fire place to not have a screen on it, and a deficiency was cited on today's date.

LPA Vanegas reviewed medications with Administrator (AD) Lynette Dizon and per LPA review all medications are being administered per physicians orders. LPA Vanegas Reviewed P&I with lead direct support staff Don Enriquez all balances were checked and per LPA Vanegas review all balances were accurate and accounted for.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/16/2025 04:02 PM - It Cannot Be Edited


Created By: William Vanegas On 01/16/2025 at 03:36 PM
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: 01/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(c)
Fixtures, Furniture, Equipment, and Supplies
(c) Fireplaces and open-faced heaters shall be inaccessible to clients to ensure protection of the clients' safety.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above per LPA observation there was no fire place screen in front of the fire place which poses a potential safety risk to persons in care.
POC Due Date: 01/23/2025
Plan of Correction
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Administrator will order a fire place screen online and send proof of correction to LPA Vanegas by P.O.C due date via email.
Type B
Section Cited
CCR
85165(h)(1)(A)
(h) The licensee shall maintain a written record of the staff training.(1) Documentation of the training received by each staff member shall be maintained in the personnel records, pursuant to Section 80066, and include:(A) Dates, hours, and description of the training completed, including name of the instructor and organization providing the training.


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 in one of four staff members not having documented training in their file which poses a potential health and saftey risk to persons in care.
POC Due Date: 01/23/2025
Plan of Correction
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Licensee will obtain records of training, and T.B test results by POC due date and send proof of correction via email to LPA Vanegas.
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:William Vanegas
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2025


LIC809 (FAS) - (06/04)
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