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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005362
Report Date: 03/10/2022
Date Signed: 03/10/2022 11:13:32 AM

Document Has Been Signed on 03/10/2022 11:13 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
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: 1DATE:
03/10/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maria VoelkerTIME COMPLETED:
11:17 AM
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Licensing Program Analyst (LPA) Jerome Haley an unannounced case management visit and health and safety check. Via telephone, LPA spoke with Administrator (AD) Linda Phuong Linh Tran, who is currently out of town. AD contacted facility staff 1 (S1), who arrived at the door and let me in the facility.

LPA Haley was greeted and granted entry by S1 and explained the reason for today's visit. LPA was screened and temperature checked at the facility entrance. LPA observed a screening station at the facility entrance, with hand sanitizer, surgical mask, disinfectant wipes, a temperature thermometer, and a temperature log sheet for visitors.

S1 led LPA Haley on a tour of the interior and exterior of the facility. There is currently one client at the facility and five clients at day program. All staff rooms are equipped with the required furniture, clean linen, lamp, and storage space. LPA toured the kitchen, and it was clean and organized. There's a two-day supply of perishable food items, and a seven-day supply of nonperishable food items. LPA toured the backyard area and observed a shaded patio area equipped with tables and chairs. There were no bodies of water observed.

LPA verified the current contact information (telephone numbers and email address) for the facility is correct with S1.

LPA did not observe any immediate threats on the health and safety of clients in care. No citation was issued during this visit.

LPA Haley conducted exit interview with S1 and left a copy of this report in the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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