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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005447
Report Date: 06/19/2023
Date Signed: 06/19/2023 11:08:17 AM


Document Has Been Signed on 06/19/2023 11:08 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:LAMBERT HOME CAREFACILITY NUMBER:
306005447
ADMINISTRATOR:ASAWADILO, YANINEEFACILITY TYPE:
740
ADDRESS:8191 LAMBERT DRIVETELEPHONE:
(714) 848-1982
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
06/19/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Caregivers Patsitta Charankanokrat and Paul KitnukulTIME COMPLETED:
10:00 AM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced case management visit in conjunction with follow up on complaint visit 22-AS-202220711084817. LPA was granted entry by staff. LPA identified themselves and discussed purpose of the visit with Caregivers Patsitta Charankanokrat and Paul Kitnukul.

During visit LPA toured physical plant including Resident rooms, kitchen, Outside patio, living room and garage. During visit Administrator Yaninee Asawadilokchai called facility and LPA explained purpose of visit. Administrator was unable to come down to facility due to another appointment. LPA confirmed with Administrator they would conduct visit report with Caregiver Paul Kitnukul.

During visit LPA reviewed resident files. Facility currently has 6 residents residing at home. Five out of six resident files were up to date. LPA inquired about Resident 6, to which Caregiver Kitnukul stated resident moved in two days ago. Resident agreement and emergency contact information needs to be completed. All residents have updated Physician's Reports and medication lists. During visit LPA reviewed three residents medications which were all centrally stored inside a locked closet. At time of visit Four out of Six residents were present. Two residents were observed relaxing in rooms watching TV, one resident was relaxing in living room reading, Fourth resident was observed asleep inside room. LPA was informed two other clients were out of house at medical appointments. All residents present looked neatly groomed in appearance and Three out of Four stated to LPA they were comfortable at facility. At time of visit no health and safety concerns to note.

LPA conducted exit interview with staff. LPA left copy of LIC 811 confidential names list and Report
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2023
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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