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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004676
Report Date: 11/14/2024
Date Signed: 11/14/2024 10:45:24 AM

Document Has Been Signed on 11/14/2024 10:45 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SHERCON GUEST HOMESFACILITY NUMBER:
306004676
ADMINISTRATOR/
DIRECTOR:
CONSOLACION LUMAUIGFACILITY TYPE:
740
ADDRESS:13432 GALWAY STREETTELEPHONE:
(714) 815-9214
CITY:GARDEN GROVESTATE: CAZIP CODE:
92844
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Consolacion "Connie" LumauigTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility to conduct a Required - 1 year inspection. LPA identified herself and was granted entry into the facility by Licensee/Administrator (AD) Consolacion "Connie" Lumauig. Facility appears clean, safe and sanitary. Administrator (AD) Lumauig certificate expires on 08/08/2025.

Six residents and 2 staff were present during today's visit. Four of the six residents are receiving Hospice care. LPA, along with AD Lumauig toured the physical plant. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Bathrooms were checked, toilets, faucets worked properly and showers are free of mold/mildew. Hot water temperature is within regulatory requirements. Bath towels, toiletries and personal hygiene supplies are adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Kitchen is clean and organized. LPA noted repair is being done under the kitchen sink due to a water leak. Per AD repair should be completed in a couple days. Perishable and non-perishable food supply was checked and adequately stocked. LPA observed sharps and cleaning supplies are inaccessible to the residents. Facility is equipped with working smoke detectors and carbon monoxide detectors. Fire extinguisher was fully charged and mounted. No bodies of water were observed outside. Walkways around the home were clear of hazards. Backyard has a covered patio with furniture for Residents and visitors. Emergency/Fire Drills are conducted but not documented. LPA observed emergency supplies including food and water. LPA reviewed 6 resident files and 1 staff file. Medication was observed to be in a centrally stored location and medication reviewed appeared to have been dispensed accurately.

Based on the observations made during today’s visit, no deficiency is being cited. This report was discussed with AD Lumauig and a copy of LIC809 and LIC9102 Advisory were sent to the email on file.
Lourdes MontoyaTELEPHONE: (714) 748-2936
Lydia MartinezTELEPHONE: (714) 705-6004
DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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