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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006523
Report Date: 07/08/2024
Date Signed: 07/08/2024 11:10:20 AM

Document Has Been Signed on 07/08/2024 11:10 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:LCS HOMES 2FACILITY NUMBER:
306006523
ADMINISTRATOR/
DIRECTOR:		CECIL P SANTOSFACILITY TYPE:
735
ADDRESS:7935 BLACKBERRY CIRCLETELEPHONE:
(714) 595-0153
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 4CENSUS: 0DATE:
07/08/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Cecil Santos
Leonardo Santos 		TIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analysts (LPA) Jerome Haley conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA Haley met with Applicant Cecil Santos and Leonardo Santos and toured the facility.

An initial application to operate an Adult Residential Facility (ARF) was submitted to CCL on March 25, 2024. The facility has a capacity of 4, of which 1 can be non-ambulatory. The facility phone number 714.735.8565

An initial application to operate an Adult Residential Facility, with a capacity of 4 was submitted to the department on March 25, 2024.

Fire clearance: Orange County Fire Authority granted the fire clearance March 18, 2024.

Structure: The facility is one level structure with 4 bedrooms and 1 and a half bathrooms.

Kitchen: Clean and organized. Sharps locked under the sink. Perishable food supply will be stored in the refrigerator and freezer. Non-perishable food supply will be stored in the cabinets.

Food Service: A sample menu was posted on the refrigerator.

Bathrooms: There are 1 and a half bathrooms for clients. All bathrooms had a working toilet, sink and all grab bars were tightly secured to the wall.

Continued on LIC809C pg 1 of 3
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2024
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 3
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: LCS HOMES 2
FACILITY NUMBER: 306006523
VISIT DATE: 07/08/2024
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Water Temperature: Hot water was measured in both bathrooms. Hot water was measured at 112.2 degrees F and 116.6 degrees F.

Hygiene Supplies: The facility has an adequate supply of hygiene items on hand. Hygiene items, and clean linens are stored in locked cabinets next to the bathroom across from bedroom #3.

Smoke Detectors/Carbon Monoxide Detectors:
Smoke detectors are hardwired and tested operational. There’s a fire extinguisher mounted on the wall in the kitchen near the sink.

Appliances:
There’s one 4 burner gas stove which lights unassisted, 1 oven, microwave, 2 refrigerators, rice cooker, dishwasher, washer, and dryer. All appliances are clean and operational.

Toxins:
All cleaning supplies and chemicals are kept locked in the kitchen.

Medications, First-Aid Kit & Book:
Client medications will be locked in a hallway closet. In the lock medication cabinet are 4 emergency bags for the clients, a first aid kit with all required elements, and a box of flashlights and batteries.

Resident & Staff Files:
Client and Staff records will be kept in the garage in locked cabinets above the office space in the garage.

Reading Material, Games, Equipment & Materials:
Connect 4, Jenga, Dominoes, Bingo, etc.

Continued on LIC809C

pg 2 of 3


SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: LCS HOMES 2
FACILITY NUMBER: 306006523
VISIT DATE: 07/08/2024
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Backyard: Clean and organized. Pool area surrounded by a 5 ft fence that's self-closing and self-latching.
There’s a shaded area with a table, chairs, and a bench. Side exit gate is self-closing and self-latching.

Garage: Clean and organized. Washer and Dryer. Refrigerator used to store additional food items. Small office area set up with a computer, and printer.

Component III: was waived as the applicant operates a licensed facility.

No deficiencies were observed during the inspection. The facility is ready for licensure.

Exit interview was conducted and a copy of this report was provided.

pg 3 of 3

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3