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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005862
Report Date: 12/17/2024
Date Signed: 12/17/2024 04:15:22 PM

Document Has Been Signed on 12/17/2024 04:15 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
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:
12/17/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:19 PM
MET WITH:Jaehyun HyeonTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 12/17/2024 Licensing Program Analyst (LPA) William Vanegas and Licensing Program Manager (LPM) Alisa Ortiz made and unannounced visit for the purposes of continuing an annual visit previously conducted on December 04, 2024.. LPA and LPM were greeted by caregiver Fe and LPA explained the purpose of our visit. During today's visit LPA and LPM reviewed the following:

LPA Vanegas reviewed four client files and all files had necessary forms and no deficiency's were cited. LPA Vanegas also reviewed medication and medication log. Medications are being documented and administered per physicians orders as evidenced by LPA review of MAR and review of medication bubble packs. LPA Vanegas also reviewed one staff file and confirmed that T.B test was negative and filed in staff file. LPA Vanegas also reviewed PNI and all client money was documented and accounted for.

LPA Vanegas conducted interview with Staff member Fe P. and one of four clients.

Based on today's observations no deficiency's will be cited an exit interview was conducted and a copy of this report and a technical violation was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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