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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006612
Report Date: 01/24/2025
Date Signed: 01/27/2025 08:12:23 AM

Document Has Been Signed on 01/27/2025 08:12 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:LAVONNE HOME CARE LLCFACILITY NUMBER:
306006612
ADMINISTRATOR/
DIRECTOR:		TRUONG, KIM-PHUONG LINDAFACILITY TYPE:
735
ADDRESS:3131 KITTRICK DRTELEPHONE:
(714) 417-8079
CITY:ROSSMOORSTATE: CAZIP CODE:
90720
CAPACITY: 4CENSUS: 0DATE:
01/24/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator Kim-Phuong Linda TruongTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Brandon Lopez made an announced visit to the facility for the purpose of conducting a Pre-licensing Inspection. LPA and met with Applicant Kim-Phuong Linda Truong. LPA observed that Administrator Kim-Phuong Linda Truong has a valid Administrator certificate which expires on November 13, 2026.

An initial application to operate an Adult Residential Facility (ARF) for a capacity of four ambulatory clients was received by Community Care Licensing (CCL) on July 25, 2024. This is an initial application with no clients in care. The facility received an approved Fire Clearance by Orange County Fire Authority Inspector Anthony Vasily on September 9, 2024.

The facility is a one story home with three client bedrooms, three client bathrooms, two of which are shared, a family room, a kitchen, a dining room, a living room, a laundry room, and an unattached two car garage. LPA accompanied by the Applicant conducted a tour of the physical plant. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the entryway of the facility. LPA observed the facility has all the required documents posted in the entryway of the facility. LPA inspected the three client bedrooms. The three client bedrooms are clean and free of hazards. LPA observed all the client bedrooms has the required furnishings of a bed, a chair, a chest of drawers, and a lamp. Client beds have clean linens and blankets. LPA observed additional linens stored in a hallway closet. Client bathrooms are clean. Faucets and toilets were operational. LPA observed the trash cans in the client bathrooms did not have a tight fitting cover. Hot water temperature measured between 117.8 and 123.3 degrees Fahrenheit. LPA observed a locked cabinet in the hallway which will be used to store client medication, client Personal and Incidental expenses (P&I), client files, staff files, and a First Aid kit. LPA reviewed the First Aid kit and observed it to have all the required components. LPA observed the facility has an internet device dedicated for client use located in the dining room.

LPA observed the kitchen has a minimum two day perishable and seven day non-perishable food supply on hand. CONTINUED ON LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: LAVONNE HOME CARE LLC
FACILITY NUMBER: 306006612
VISIT DATE: 01/24/2025
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LPA observed a three day supply of emergency food and water to be stored in the pantry. LPA observed the dual gas/electric stove, the refrigerator, the microwave, the two ovens, and the dishwasher to be clean and operational. LPA observed knives to be stored in an unlocked kitchen cabinet. LPA observed chemicals to be stored in an unlocked kitchen cabinet under the sink. Fire extinguishers are located in the kitchen, in the family room, and in the hallway by the clients rooms. Fire extinguishers were observed to be charged and purchased as of July 9, 2024 and August 7, 2024. LPA tested the wired smoke/carbon monoxide detectors which tested operational. The unattached two car garage is kept locked and will be inaccessible to clients in care. The unattached two car garage will be used for storage.

LPA accompanied by the Applicant toured the exterior portion of the facility. LPA observed construction materials and wood pallets in the backyard. LPA observed an open construction container with trash and debris in the backyard driveway. LPA observed a shaded outdoor seating area with furniture for client use. The perimeter gate on the north side of the facility is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises.

Based on the observations during today's visit, the facility is not ready to be licensed. The applicant agreed to make the following corrections by January 27, 2025:
  • The applicant will add a lock to the kitchen cabinet that will be used to store knives and other sharp objects.
  • The applicant will add a lock to the kitchen cabinet under the sink that will be used to store all chemicals and toxins.
  • The applicant will add a tight fitting cover to all the trash cans in the client bathrooms.
  • The applicant will adjust the water temperature to be within the regulatory requirements of 105 to 120 degrees Fahrenheit.
  • The applicant will remove all the obstructions and hazards observed in the exterior portion of the facility.
  • The applicant will purchase activity equipment and/or supplies for client use.

LPA will conduct a subsequent visit to verify the corrections listed above are made. The Component III presentation was not completed today and will be conducted on the subsequent visit. An exit interview was conducted with Applicant Kim-Phoung Linda Truong and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
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