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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006288
Report Date: 10/01/2024
Date Signed: 10/01/2024 05:17:08 PM

Document Has Been Signed on 10/01/2024 05:17 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:WE CONQUER TOGETHER LLCFACILITY NUMBER:
306006288
ADMINISTRATOR/
DIRECTOR:		MENDEZ, ALBERTFACILITY TYPE:
772
ADDRESS:17367 ASPENGLOW LANETELEPHONE:
(626) 272-4246
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 6CENSUS: 3DATE:
10/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Albert MendezTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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On October 1, 2024, at 12:30pm, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Administrator (AD) Albert Mendez and explained the purpose of the visit.

The facility is licensed to operate for six (6) ambulatory clients. The facility is a two-story structure located in a residential neighborhood. It consists of the following: five (5) client bedrooms, four (4) bathrooms, living area, dining area, laundry room, kitchen, and attached 2-car garage.

LPA toured the indoor and outdoor physical plant with AD Mendez. There was shading and sufficient seating for the clients. LPA observed that the client bedrooms had all required elements with ample lighting. Showers, faucets, and toilets were sanitary and in operating condition. The hot water temperature measured at 106.7 degrees Fahrenheit to 115.6 degrees Fahrenheit in all bathrooms. There were sufficient and clean supply of linens. LPA observed ample two-day supply of perishables and seven-day supply of non-perishables. LPA observed the emergency food, emergency water, and emergency supplies stored in the garage. The carbon monoxide and smoke detectors were tested and operational. There are two (2) fire extinguisher that are securely mounted in kitchen and second floor hall and serviced on September 27, 2024. Medications, sharps, and toxins were locked and inaccessible to the clients. The following items were all posted and available for review: Emergency Disaster Plan (LIC610D), food menu, and client rights. LPA reviewed three out of the three client files/medications and five staff files during today's visit. LPA Kim and AD Mendez reviewed the client's funds and noted that the expenses complete and in order.

Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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 10/01/2024 05:17 PM - It Cannot Be Edited


Created By: Edward Kim On 10/01/2024 at 04:54 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: WE CONQUER TOGETHER LLC
FACILITY NUMBER: 306006288

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
81068(c)11
81068 Admission Agreements (c)Admission agreements must specify the following: (11) An indication of whether the client is either receiving or is eligible to receive Short/Doyle payments pursuant to Welfare and Institutions Code sections 5700 through 5750.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above LPA observed in the Admission's Agreement for Client #1, Client #2, and Client #3 was missing an indication or receiving Short/Doyle payments in the admission agreement. This poses a potential health, safety or personal rights risk to persons in care
POC Due Date: 10/15/2024
Plan of Correction
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Licensee states they will turn in an signed Admission Agreement that includes missing Short/Doyle Indication for Clients C1, C2, and C3 to CCLD via email edward.kim@dss.ca.gov by POC Due Date October 15, 2024.
Type B
Section Cited
CCR
81069(f)(4)
81069 Client Medical Assessments (f) The medical assessment shall include the following: (4) A determination of the client's ambulatory status, as defined in Section 81001(n)(2).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above. LPA observed the Medical Assessment was missing whether the client's ambulatory status as ambulatory, nonambulatory, or bedridden for Client#1, Client#2, and Client#3. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/15/2024
Plan of Correction
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Licensee states they will submit a new Physician's Report LIC602 for Clients C1, C2, and C3 to CCLD via email to edward.kim@dss.ca.gov by POC due date October 15, 2024.
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:Lourdes Montoya
LICENSING EVALUATOR NAME:Edward Kim
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024


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: WE CONQUER TOGETHER LLC
FACILITY NUMBER: 306006288
VISIT DATE: 10/01/2024
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Based on today's observations, Deficiencies are being cited as per the Title 22 Division 6 Chapter 2 of the California Code of Regulations.

An exit interview was conducted with Administrator Albert Mendez, and a copy of this report including the appeal rights were issued at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
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