<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006378
Report Date: 10/18/2023
Date Signed: 10/18/2023 03:33:25 PM

Document Has Been Signed on 10/18/2023 03:33 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LANTANA HOMEFACILITY NUMBER:
306006378
ADMINISTRATOR:SHARMA, NARESHFACILITY TYPE:
735
ADDRESS:7704 LANTANA DRTELEPHONE:
(714) 858-2351
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 4CENSUS: DATE:
10/18/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Naresh Sharma - AdministratorTIME COMPLETED:
03:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection follow up. LPA arrived at the facility at 3:10 pm and was greeted and granted entry by designated Administrator (AD) Naresh Sharma. LPA toured the facility to confirm the following corrections have been made:
1. Facility must have, on hand, their Plan of Operation and Infection Control Plan

2. Facility must provide a table in outdoor patio in order to provide a comfortable outdoor seating/activity area

3. Facility must clear the backyard of the following: the pile of cardboard boxes, doghouse, crate of unused bathroom tiles, rusted paint can, unused trash cans and the bags of fertilizer that have been ripped open

4. Facility must send via email an updated facility sketch reflecting the backyard exit route and assembly point to their CAB Analyst and LPA

5. Facility must provide activity supplies and post menu in facility for view

LPA observed the following:

1. Facility has, on hand, their Plan of Operation and Infection Control Plan

2. Facility has a table in outdoor patio in order to provide a comfortable outdoor seating/activity area

3. Facility's backyard is clear of debris and unused items

4. Facility has updated their facility sketch and submitted it to Licensing and CAB

5. Facility has activity supplies and the menu is posted.

The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2023
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 1