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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003903
Report Date: 11/22/2021
Date Signed: 11/22/2021 12:08:48 PM

Document Has Been Signed on 11/22/2021 12:08 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CYNCO CHILD CAREFACILITY NUMBER:
306003903
ADMINISTRATOR:CORAZON ARANDAFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6CENSUS: 3DATE:
11/22/2021
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Corazon PasionTIME COMPLETED:
12:18 PM
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On November 22, 2021 at 10:25am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct a Required Annual inspection of the facility. The facility was inspected inside and out with Administrator Corazon Pasion and Facility Manager Francisco Aranda. The home is a one story residence with four bedrooms and one and a half bathrooms.

Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client’s belongings. The bathrooms were clean and in good repair. The hot water in the kitchen was measured at 107.6 degrees, which is within regulatory requirements. All hazardous items have been properly made inaccessible to areas where clients will not have access. The medications were stored and locked in a cabinet in the kitchen. Cleansers/chemicals are locked and stored in a cabinet in the garage. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen. The First Aid Kit is located in a locked cabinet in the kitchen and contained all required supplies. The facility's smoke/carbon monoxide detectors in the hallway and bedrooms were checked and were operable. There are no guns or weapons in the facility as stated by Facility Manager. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan and current menu.

The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Due to the need to complete staff/client interviews and staff/client file reviews, this inspection will need to be continued at later date. LPA discussed and reviewed the following inspection components; Operations, Emergency Intervention Plan, and Emergency Disaster Preparedness.

Based on the facility inspection, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained and provided to Administrator Corazon Pasion.
SUPERVISORS NAME: Ann Valenzuela
LICENSING EVALUATOR NAME: Adrian Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2021
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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