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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005489
Report Date: 08/28/2024
Date Signed: 08/28/2024 09:42:32 AM

Document Has Been Signed on 08/28/2024 09:42 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 COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LANCER HOME CARE INCFACILITY NUMBER:
306005489
ADMINISTRATOR/
DIRECTOR:		LU, LAURENFACILITY TYPE:
735
ADDRESS:667 N LANCER DRTELEPHONE:
(714) 829-4314
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 4CENSUS: 4DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:15 AM
MET WITH:Lauren Lu- AdministratorTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year evaluation using the Care Inspection Tool. LPA Cho was greeted and granted entry by Care Staff Librogelito Orillaza. Administrator (Admin) Lauren Lu arrived on premise to assist with the inspection.

The facility is a single story structure located in a residential neighborhood. Facility is licensed to serve three (3) ambulatory and one (1) non-ambulatory clients. There are three clients in care during today's visit with three care staff on duty.

LPA observed the facility to be clean and sanitary. There are four client bedrooms and three client bathrooms. All common areas were inspected including the laundry room and the attached two car garage which doubled as an office. The clients' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The water temperature measured at 113.0, 116.7, and 117.3 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway free of obstruction. The exit gate was self-closing and self-latching. LPA observed sufficient seating and shading. Facility maintains a fire extinguisher which was mounted, charged, and serviced on May 16, 2024. The dual-functioning smoke/carbon monoxide detectors were tested and operational. LPA observed the emergency disaster supplies including food/water in the garage. Emergency evacuation drills are being conducted every two months. The first aid kit contains all necessary elements.
The Administrator's Certificate for Lauren Lu expires on November 18, 2024.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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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: LANCER HOME CARE INC
FACILITY NUMBER: 306005489
VISIT DATE: 08/28/2024
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LPA conducted an audit of four client files and three personnel files. No discrepancies were noted. Staff and client interviews were attempted and conducted for one client/staff. Medications were audited for four clients. No discrepancies noted.

Based on the observations made during today's visit, no deficiency is being cited today.

An exit interview was conducted with Administrator Lauren Lu, and a copy of this report was provided at the end of the visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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