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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006035
Report Date: 10/07/2022
Date Signed: 10/07/2022 02:38:06 PM

Document Has Been Signed on 10/07/2022 02:38 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:LCS HOMES/POINSETTIAFACILITY NUMBER:
306006035
ADMINISTRATOR:SANTOS, CECILFACILITY TYPE:
735
ADDRESS:7912 POINSETTIA DRIVETELEPHONE:
(714) 600-9896
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 4CENSUS: 3DATE:
10/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:42 PM
MET WITH:Cecila Santos TIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year infection control annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. Staff called the Administrator (AD) Celia Santos who arrived and was present for the visit. AD Santos has a current administrators certificate that expires 8/2/23.

At 1:20 PM LPA Haley began the tour of the facility with AD Santos. There were three clients present for the visit. There are four client bedrooms in the facility and one client bedroom is vacant at this time. All four client bedrooms were clean, well organized, and had all necessary requirements: night stand, chair, lamp and storage space. In client bedroom #1 the bathroom hot water temperature was measured at 109.5 degrees Fahrenheit. In a hallway closet LPA Haley observed an emergency non-perishable food supply, emergency water, and a disaster kit.

Bathroom 1 was clean and organized, and hot water temperature was measured at 106.7 degrees Fahrenheit. LPA observed a locked cabinet with all the clients hygiene items in the bathroom.

In the living room LPA Haley observed a locked medication closet near the front door. A first aid kit with all required elements was observed in the medication closet. Emergency bags prepared for each client was observed. Furthermore, there was a screening station near the front door with a temperature thermometer, hand sanitizer, and face mask.

The kitchen was clean and organized. All knives and sharp objects were locked in a drawer next to the stove. All burners on the stove were operational. The facility has a two day supply of perishable food items and seven day supply of non-perishable food items

The garage was clean and very well organized. The walkways were free of clutter and tripping hazards. LPA observed an abundant supply of PPE, cleaning supplies, and other miscellaneous items like light bulbs, and batteries.


Continued on LIC809C Dated 10/7/22
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2022
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: LCS HOMES/POINSETTIA
FACILITY NUMBER: 306006035
VISIT DATE: 10/07/2022
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The garage was clean and very well organized. The walkways were free of clutter and tripping hazards. LPA observed an abundant supply of PPE, cleaning supplies, and other miscellaneous items like light bulbs, and batteries.

The back yard was clean and organized. All hazardous chemical are locked in a cabinet in the backyard. A shaded area with chairs and a small table was observed. There was an additional refrigerator in the back yard with an additional supply of perishable food items. LPA Haley observed a stationary bike and a heavy bag as well. There was a side exit gate that was self closing and self latching.

There were no bodies of water observed. All smoke detectors were tested and are operational. No deficiencies are being cited during todays visit. An exit interview conducted and a copy of the report was provided to the Administrator Santos.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
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