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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005862
Report Date: 12/04/2024
Date Signed: 12/04/2024 05:06:15 PM

Document Has Been Signed on 12/04/2024 05:06 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:LORANE WAY HOMEFACILITY NUMBER:
306005862
ADMINISTRATOR/
DIRECTOR:		SOONTHORNPONG, SUPARBFACILITY TYPE:
735
ADDRESS:1587 W LORANE WAYTELEPHONE:
(714) 537-6570
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 4CENSUS: 4DATE:
12/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Jaehyun HyeonTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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On 12/04/2024 at 1:00PM Licensing Program Analyst (LPA) William Vanegas and Licensing Program Manager (LPM) Alisa Ortiz made an unannounced visit for the purposes of an annual visit. Upon arrival LPA and LPM were greeted and granted entry to the facility by Direct Support Staff (DSP) Jaehyun Hyeon we then explained the purpose of the visit. Administrator Suparb Soonthornpong (AD) arrived at facility shortly after LPAs arrival. LPA and LPM started a tour of the facility at 1:15pm and observed the following.

This is a one story home with four client bedrooms, one staff bedroom, and one client restroom, and one staff restroom. All client bedrooms were observed to be in clean and sanitary condition with all required furnishings including a bed with linens that appeared to be in good condition, meaning no tears or strains, a lamp, chair, and chest drawers, with required amount of closet space for personal belongings.

LPA Vanegas observed the client restroom to be free of mildew and debris with a functional toilet and working faucets, However water temperature tested below the required temperature of 105-120 Degrees F. Water tested at 104.0 Degrees F. LPA observed smoke detector log to be up-to-date and all were operational per last fire alarm inspection. LPA observed Kitchen to be in clean and sanitary conditions with tight lid trash can available. LPA observed a dishwasher, microwave, gas stove, and washer and dryer that all tested operational and in good condition.

LPA Vanegas observed backyard of facility to be free of any obstructions along the emergency exit route, side doors are self latching and were not locked. There is an outdoor sitting area, and an umbrella available if requested by clients. LPA Vanegas observed 11/10 staff records to have all the required staff documentation, however one staff member did not have a TB test on file. He went to a near by urgent care to get an updated TB Test.
CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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: LORANE WAY HOME
FACILITY NUMBER: 306005862
VISIT DATE: 12/04/2024
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and will have a result as soon as Friday 12/06/2024. Administrator agreed staff member will not work until results are received. LPA Vanegas advised that due to time constraints LPA Vanegas and LPM Ortiz will need to end the visit and come back to continue the annual inspection on a different day.

No deficiencies cited at this time.

An exit interview was conducted and a copy of this report was left at the facility with AD.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
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