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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005862
Report Date: 11/03/2022
Date Signed: 11/03/2022 03:15:02 PM

Document Has Been Signed on 11/03/2022 03:15 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LORANE WAY HOMEFACILITY NUMBER:
306005862
ADMINISTRATOR:SOONTHORNPONG, SUPARBFACILITY TYPE:
735
ADDRESS:1587 W LORANE WAYTELEPHONE:
(714) 537-6570
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 4CENSUS: 4DATE:
11/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:54 PM
MET WITH:Suparb SoonthornpongTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with Administrator Suparb Soonthornpong and stated the purpose of this visit.

The facility is a single level structure and licensed for four ambulatory of which two may be non-ambulatory. This facility offers care for the Developmentally Disabled.

At about 1:54 pm, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed clients in care and staff members on the duty. LPA toured the interior and exterior portions of the facility. There were 4 client rooms. The facility offers 2 staff rooms which are inaccessible to clients. Clients rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Manual smoke detectors and carbon monoxide were tested to be operational. Bathrooms were observed to be in good repair and hot water was measured at 105.4 degrees Fahrenheit. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements, cleaning supplies and sharp items were inaccessible to clients in care. Facility had adequate supplies of personal protective equipment in place. Fire extinguisher was observed. Laundry room was in good repair with detergents kept locked. Medications where kept locked and away from clients. Kitchen was in good repair with knifes and cleaning supplies kept locked.

For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. The backyard contained fruit and vegetable plants that were well maintained.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Edward Tapia
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: LORANE WAY HOME
FACILITY NUMBER: 306005862
VISIT DATE: 11/03/2022
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LPA Tapia reviewed the COVID 19 mitigation plan and the Emergency Disaster plan of the facility.

LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For this visit, no deficiency was noted in areas observed.

LPA Tapia conducted an exit interview with Administrator Suparb Soonthornpong and copy of this report was explained and left in the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Edward Tapia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
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