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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005362
Report Date: 03/02/2022
Date Signed: 03/02/2022 04:13:03 PM

Document Has Been Signed on 03/02/2022 04:13 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LP CARE HOMEFACILITY NUMBER:
306005362
ADMINISTRATOR:TRAN, LINDAFACILITY TYPE:
735
ADDRESS:8791 MONTEREY CIRCLETELEPHONE:
(714) 622-5764
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 6CENSUS: 6DATE:
03/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Marie Voelker, CaregiverTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit in order to conduct a required annual inspection. LPA arrived at facility, was greeted and screened for COVID symptoms by caregiver Marie Voelker and granted entry after explaining the purpose of the visit.

At approximately 3:20pm, LPA accompanied by staff began the tour of the facility. There are currently six (6) clients in care. Five (5) of the clients are away and one (1) is observed relaxing in the common areas and appears well taken care of. Facility appears to be clean, sanitary and free of odors in all areas inspected. Each bedroom is observed to have all required components and bathrooms are equipped with grab bars and slip mats.
LPA observed temperature checks are being done for visitors, staff and clients. LPA observed the facility has COVID-19 Precautions posters, all required department postings and hand washing signs posted throughout. LPA observed a sufficient supply of food and water. A 30-day supply of medication is stored and locked in a kitchen cabinet. Facility has an adequate supply of PPE in the attached garage. LPA toured the outside of the facility. Outdoor space is free of debris and well-maintained with self-latching gates that can easily be opened. The garden shed will be kept locked due to the presence of tools and gardening supplies. There are no bodies of water on the premises.
The facility has completed and submitted their LIC808 Mitigation Plan on 07/07/2021. COVID precautions and Infection Control measures were discussed over the phone with Administrator Phil Tran.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2022
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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