<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005489
Report Date: 08/15/2022
Date Signed: 08/15/2022 11:07:29 AM

Document Has Been Signed on 08/15/2022 11:07 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:LANCER HOME CARE INCFACILITY NUMBER:
306005489
ADMINISTRATOR:LU, LAURENFACILITY TYPE:
735
ADDRESS:667 N LANCER DRTELEPHONE:
(714) 829-4314
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 4CENSUS: 2DATE:
08/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Librogelito OrillazaTIME COMPLETED:
11:25 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Administrator Lauren Lu has an Administrator's Certificate that expires 11/18/22. LPA and staff toured the facility. Facility is a single story home that has four bedrooms, three bathrooms, living room, dining room, family room, kitchen and a two car garage. The family room has a fireplace that is screened. PA observed All fire extinguishers are fully charged. The kitchen is clean and organized. LPA observed a two day perishable, and a seven day non-perishable food supply on hand. LPA observed the first aid kit did not contain a first aid manual but had all the other required elements. All three bathrooms were clean and organized. Hot water measured 112.4 degrees Fahrenheit. Smoke detectors/carbon monoxide detectors tested operational. All 3 bedrooms were clean and organized. All bedrooms had the required linens and furniture The backyard has a covered patio with a seating area for clients. The backyard exit door is operational. No bodies of water observed. There is a shed that is used to store tools and gardening supplies. The shed is kept locked. The garage is kept locked and used to store extra food. No obstacles or hazards observed inside or outside of the facility. LPA consulted with staff in regards to continued Covid-19 mitigation and reporting requirements. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2022
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 1