306005447-3-11-2025-22-AS-NGUN-DENQDB-20250311120428

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005447
Report Date: 03/11/2025
Date Signed: 03/11/2025 12:04:59 PM

Document Has Been Signed on 03/11/2025 12:04 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:	LAMBERT HOME CARE		FACILITY NUMBER:	306005447
ADMINISTRATOR/ DIRECTOR:	ASAWADILO, YANINEE		FACILITY TYPE:	740
ADDRESS:	8191 LAMBERT DRIVE		TELEPHONE:	(714) 848-1982
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92647
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	03/11/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:17 AM
MET WITH:	Maria Praedes- Caregiver		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by caregiver Maria Praedes after explaining the purpose of the visit. Administrator (AD) Yaninee Asawadilokchai was notified via telephone and later arrived to assist with the inspection. LPA observed the Administrator certificate was current and expires October 23, 2025. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents, of which one may be bedridden, with a hospice waiver for three. The facility is a two story home with the first floor consisting of four resident bedrooms, two resident bathrooms, a kitchen, living room and an attached garage. The second floor consists of one staff bedroom and bathroom.

While waiting for the AD, LPA began review of the records. LPA reviewed three resident records. All the required documentation were present and current in the residents’ files reviewed. LPA reviewed three employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPA observed records reviewed have a current First Aid certificate.

During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

LPA observed residents watching television in the living room and resting in their respective bedrooms. LPA observed three residents in care and three staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall by the entry way. All resident bedrooms had the required furnishings, however two resident’s had hospital beds with ½ bed rails without a doctors order; a deficiency was cited on today’s date. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet.

LIC 809C

Armando J Lucero	TELEPHONE: (714) 703-2866
Nancy Guillen	TELEPHONE: (714) 724-3542
	DATE: 03/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

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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Document Has Been Signed on 03/11/2025 12:04 PM - It Cannot Be Edited

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: LAMBERT HOME CARE	FACILITY NUMBER: 306005447
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87465(h)(1)(C)

Incidental Medical and Dental Care Services

(h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in one out of three medical records, which poses an immediate health and safety risk to persons in care. Senna 8.6mg was given to R2 without a doctor's order, that was prescribed to a different resident who is no longer at the facility.
	POC Due Date: 03/12/2025
	Plan of Correction
1 2 3 4	Licensee to provide doctor's order for R2 for Senna 8.6mg to LPA via email by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Armando J Lucero	TELEPHONE: (714) 703-2866
Nancy Guillen	TELEPHONE: (714) 724-3542
	DATE: 03/11/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/11/2025 12:04 PM - It Cannot Be Edited

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: LAMBERT HOME CARE	FACILITY NUMBER: 306005447
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

HSC

1569.695(c)

Other Provisions

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which pose a potential health, safety and personal rights risk to persons in care.Per staff interview and record review, disaster drills are not being conducted.
	POC Due Date: 03/18/2025
	Plan of Correction
1 2 3 4	Licensee to conduct a disaster drill by POC date and send log to LPA via email. Licensee to conduct disaster drill quarterly.

Type B

Section Cited

CCR

87608(a)(3)

Postural Supports

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in two out of three resident records, which poses a potential safety rights risk to persons in care. Resident 1 and 2 have hospice beds with 1/2 rails with no doctor orders.
	POC Due Date: 03/18/2025
	Plan of Correction
1 2 3 4	Licensee to proovide doctor's orders for R1 and R2 to LPA via email by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Armando J Lucero	TELEPHONE: (714) 703-2866
Nancy Guillen	TELEPHONE: (714) 724-3542
	DATE: 03/11/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

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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: LAMBERT HOME CARE	FACILITY NUMBER: 306005447
	VISIT DATE: 03/11/2025

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LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. LPA observed all windows were appropriately screened. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 119.4 and 119.8 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had furniture for resident use. LPA observed a swimming pool with a fence around it with a self latching door inaccessible to residents in care.

LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged and located by the garage entrance. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be locked and inaccessible to residents in garage and inaccessible to residents in care. Medication cabinet was observed to be locked and centrally stored in the kitchen however, Senna was being administered to resident without a doctors order; a deficiency was cited on today's date. LPA observed the First Aid Kit had all the required components with the exception of the first aid manual; a Technical Violation was issued on today’s date. LPA observed the facility is not conducting quarterly disaster drills; a deficiency was cited on today’s date.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2866
LICENSING EVALUATOR NAME: Nancy Guillen	TELEPHONE: (714) 724-3542
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

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