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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005157
Report Date: 08/01/2024
Date Signed: 08/01/2024 12:14:53 PM

Document Has Been Signed on 08/01/2024 12:14 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:LCS HOMES/DIANAFACILITY NUMBER:
306005157
ADMINISTRATOR/
DIRECTOR:		LEONARDO C SANTOS JRFACILITY TYPE:
735
ADDRESS:2769 E DIANA AVETELEPHONE:
(714) 632-8487
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 6CENSUS: DATE:
08/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Leonardo Santos and Cecil SantosTIME VISIT/
INSPECTION COMPLETED:
11:55 AM
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LIC 809 was amended due to technical issue a technical violation was issued in error.

On August 1, 2024 at 8:00AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (AD) Leonardo Santos and Assistant Administrator (AA) Cecil Santos, and explained the purpose of the visit.

The facility is licensed to operate for six (6) ambulatory clients. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) client bedrooms, three (3) bathrooms, attached garage, living room, dining room, laundry area, kitchen, and outdoor covered patio area.

LPA Kim toured inside and outside of the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each client’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Client Room 1, Client Room 2, Client Room 3, Client Room 4, Client Room 5, and Client Room 6. Bathrooms were found to be clean and operational. The water temperature measured between 111.3 degrees F and 111.7 degrees F at all client bathrooms. A comfortable temperature of 68 degrees F was maintained in the facility.

LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage area for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The storage area for the sharps and cleaning supplies is locked and secured outside by the laundry area exit. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency Food, Emergency Water, and Emergency supplies for the clients are stored in the garage and laundry area. The facility has planned activities with games, puzzles, books, DVDs, and karaoke machine contained in the living room area.

Evaluation Report Continues on LIC 809-C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: LCS HOMES/DIANA
FACILITY NUMBER: 306005157
VISIT DATE: 08/01/2024
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During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and clients, and sanitizing station in the entrance. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE) in a locked storage room next to the living room area. All mandated inspection control posters were posted. A working telephone (714-632-8487) remains available. The facility has smoke detectors and carbon monoxide detectors that were operable. First Aid Kit contained all the necessary elements. The Facility has one (1) fire extinguisher that is fully charged and was serviced January 5, 2024.

LPA Kim conducted an audit of six (6) clients (C1-C6) files, six (6) staff (S1-S6) files, and medication and medication administration record that were all in order and complete. LPA conducted two (2) staff interviews and three (3) client interviews.

Based on observations made, no deficiencies were observed or cited at this time.



An exit interview was conducted, and a copy of this report was provided to Administrator Leonardo Santos and Assistant Administrator Cecil Santos.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
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