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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005610
Report Date: 06/06/2024
Date Signed: 06/06/2024 02:10:30 PM

Document Has Been Signed on 06/06/2024 02:10 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:TCT HOMES / N. COOLIDGEFACILITY NUMBER:
306005610
ADMINISTRATOR/
DIRECTOR:		AU, ANTHONYFACILITY TYPE:
735
ADDRESS:328 N. COOLIDGE AVETELEPHONE:
(714) 723-0727
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 0DATE:
06/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:26 AM
MET WITH:Augustine Au, Maxine KniazeffTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. Administrator Augustine Au arrived during the visit. Facility is a single story home with 6 bedrooms, 2 bathrooms, kitchen, dining room, great room and an attached 2 car garage. LPA observed the fireplace in the dining room is screened. LPA observed all bathrooms are clean and operational. Hot water measured 109.5 degreed Fahrenheit in all bathrooms. LPA observed all client bedrooms had the required furnishings. All client bedrooms had the required linens and bedding. All client bedrooms had a working smoke detector. All smoke detectors and carbon monoxide detectors tested operational. The fire extinguisher in the kitchen is fully charged. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the medication is kept locked in a kitchen cabinet. Knives are kept locked in a kitchen drawer. Cleaning supplies are kept locked under the kitchen sink. LPA observed the great room had a TV and plenty of room for clients to do activities. LPA and staff toured the backyard. No bodies of water observed. There are 2 sheds in the backyard. Both sheds are kept locked and used for storage. Both exit gates on each side of the house are operational. There is a shaded patio area in the backyard but there are no chairs and no table for clients to sit outside. No obstacles or hazards observed in the backyard. LPA reviewed client files. LPA observed that 6 out of 6 client files did not have an admission agreement. All 6 clients had the Regional Center of Orange County (RCOC) service agreement. No other discrepancies observed. LPA reviewed 5 staff files, no discrepancies observed. All staff are background cleared and associated to the facility. LPA reviewed client medications, no discrepancies observed. LPA reviewed client P & I monies. LPA observed, 6 out of 6 client ledgers for bank account balance did not match the bank statement. The last fire drill was conducted on June 5, 2024. No obstacles or hazards observed in the facility. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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Document Has Been Signed on 06/06/2024 02:10 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 06/06/2024 at 01:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: TCT HOMES / N. COOLIDGE
FACILITY NUMBER: 306005610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80026(h)
Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care,
This requirement is not met as evidenced by:
LPA observed that in 6 out of 6 client P & I ledgers the balance did not match the bank statement balance.
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 6 out of 6 client records which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/07/2024
Plan of Correction
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Licensee agrees to update the client records and to replace the missing money ($4399.88) in the clients' bank account. Licensee agrees to maintain all P & I records accurately and to account for all of clients' P & I monies accurately. Licensee to submit proof to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2024


LIC809 (FAS) - (06/04)
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