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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880821
Report Date: 08/15/2024
Date Signed: 08/15/2024 04:20:03 PM

Document Has Been Signed on 08/15/2024 04:20 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:DION HOME 2FACILITY NUMBER:
331880821
ADMINISTRATOR/
DIRECTOR:		OWENS, OMORODIONFACILITY TYPE:
735
ADDRESS:22905 PAVLA CTTELEPHONE:
(714) 392-1860
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY: 4CENSUS: 2DATE:
08/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:24 PM
MET WITH:Licensee Omorodion OwensTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
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On 08/15/2024 at 02:45 PM, Licensing Program Analysts (LPAs) Melody Brown and Raquel Hernandez met with Licensee Omorodion Owens to initiate Case Management Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation.

During the facility visit today, 08/15/2024, Licensing Program Analysts (LPAs) Melody Brown and Raquel Hernandez observed that Staff #2 (S2) working at the facility and per records review, S2 has background clearance, but S2 was not associated to the facility as S2's criminal background clearance was not transferred to the facility. LPAs interviewed S2 and S2 reported that S2 started working at the facility today to fill for a staff that called off sick. LPAs Brown and Hernandez informed Licensee Omorodion Owens that deficiency will be issued and Civil Penalties were assessed during the facility visit today with the amount of $100.00 for S2 and will continue to be assessed of $100.00 per day per citation until corrected for not transferring criminal record clearance for S2 to the facility prior to employment. During the visit, Licensee Owens transferred S2 criminal background clearance to the facility.

An exit interview was conducted where this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to Licensee Omorodion Owens.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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Document Has Been Signed on 08/15/2024 04:20 PM - It Cannot Be Edited


Created By: Melody Brown On 08/15/2024 at 03:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: DION HOME 2
FACILITY NUMBER: 331880821

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2024
Section Cited
CCR
80019(e)(3)

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80019 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working...(3) Request a transfer of a criminal record clearance...This requirement is not met as evidenced by:
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Licensee associated/transferred S2 criminal background clearance to the facility during the visit. Plan of Correction (POC) cleared.
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Based on obervation, interview and records review, the Licensee did not ensure that Staff #2 (S2) criminal background clearance was transferred to the facility prior to employment which poses a potential health, safety and personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Efren Malagon
LICENSING EVALUATOR NAME:Melody Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2024


LIC809 (FAS) - (06/04)
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