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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006612
Report Date: 02/03/2025
Date Signed: 02/03/2025 08:58:53 AM

Document Has Been Signed on 02/03/2025 08:58 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:
02/03/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:05 AM
MET WITH:Administrator Kim-Phuong Linda TruongTIME VISIT/
INSPECTION COMPLETED:
09:13 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 to follow up on corrections identified during the initial pre-licensing inspection, see 809 dated 01/25/25 for more details. LPA was greeted and granted entry to the facility by Applicant Kim-Phoung Linda Truong. LPA accompanied by the Applicant conducted a tour of the interior and exterior portion of the facility and observed the following:

• Knives and sharps were observed to be stored in a locked cabinet in the kitchen.
• Chemicals and toxins were observed to be stored in a locked cabinet in the laundry room.
• Tight fitting covers were observed in the trash cans located in the client bathrooms.
• The hot water temperature in the client bathrooms measured between 109.5 and 113 degrees Fahrenheit.
• The obstructions and hazards located in the backyard have been removed.
• Activity equipment/supplies were observed to be stored in the family room.

All the corrections noted on the initial pre-licensing inspection completed on 1/25/25 have been corrected.
Component III was completed with the Applicant which provided information about how to operate the facility within compliance and reporting requirements. The Applicant was notified that the final application approval will be issued by the Centralized Applications Bureau (CAB) in Sacramento. An exit interview was conducted, and a copy of this report was provided to the Applicant Kim-Phoung Linda Truong.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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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