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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006334
Report Date: 11/08/2024
Date Signed: 11/08/2024 10:40:58 AM

Document Has Been Signed on 11/08/2024 10:40 AM - 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:LANCE CARE HOMEFACILITY NUMBER:
306006334
ADMINISTRATOR/
DIRECTOR:		SAYAT, RICHARDFACILITY TYPE:
735
ADDRESS:1311 LANCE DRIVETELEPHONE:
(657) 235-8232
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 4CENSUS: 4DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Anna Mallari, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1. During today’s visit, LPA met with Francis Mallari, Licensee and Anna Mallari, Administrator.

The facility is a six bedroom, level 4i, single story building with an approved fire clearance of four non-ambulatory clients of which two may be on hospice and there are two staff bedrooms. The facility currently has a census of four clients in care. Two clients were preparing for Adult Day Program (ADP) at LPA's arrival at 8 AM and one was awaiting his mother's arrival.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperatures in two of two client bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 110.4 and 111.2 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational. The fire extinguisher is charged and was serviced on October 5, 2023. The facility’s last fire drill was conducted on September 3, 2024 and an earthquake drill was conducted on October 23, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid kit had all the required elements and the facility has a First Aid Manual book.

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of client records. Client P&I records were reviewed and were accurate. LPA interviewed alert clients regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has an administrator certificate which is pending renewal and will expire on August 31, 2026.
(Continued on LIC 809-C)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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: LANCE CARE HOME
FACILITY NUMBER: 306006334
VISIT DATE: 11/08/2024
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(Cotinued from LIC 809)
Administrator was advised to include Admissions Agreements for clients to comply with Title 22 Regulations. Admissions Agreements for Regional Center and Title 17 are on file.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Anna Mallari, Administrator and a copy of the report, LIC 9102-TV and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
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