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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004502
Report Date: 02/23/2023
Date Signed: 02/23/2023 01:56:01 PM

Document Has Been Signed on 02/23/2023 01:56 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:L & D BOARD AND CAREFACILITY NUMBER:
306004502
ADMINISTRATOR:LILIA DUELASFACILITY TYPE:
735
ADDRESS:10361 16TH STREETTELEPHONE:
(714) 867-6028
CITY:GARDEN GROVESTATE: CAZIP CODE:
92843
CAPACITY: 6CENSUS: 3DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Delia Uyl, AdministratorTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by Delia Uyl, Administrator and LPA explained the nature of the visit.

LPA Martinez accompanied by Administrator began the tour of the inside and outside of the facility. There are three clients in care and no covid cases in the facility. Upon entry LPA observed the facility to have a sign-in procedure in place. LPA observed required department postings, hand washing signs, and covid precautionary posting in the facility. Facility has a Mitigation Plan on file with CCLD. Facility has a required Emergency Disaster Plan in place. There is a minimum of one week of non-perishables and two days of perishables foods available. Facility has an emergency food and water supply. LPA toured the client’s bedrooms, all bedrooms observed to have all required components. LPA observed clients in their bedrooms, all clients appeared to be clean and well taken care of. The facility is equipped with sufficient hygiene, cleaning, and disinfecting supplies. Personal protective equipment (PPE) supply is available. Bathroom observed to have a supply of soap and toilet paper. Facility has a secure location for medication and has a 30 day supply of medication for clients. LPA toured the outside to the facility and observed a covers patio with seating and a covered seating area for client’s use.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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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