<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004178
Report Date: 03/21/2025
Date Signed: 03/21/2025 04:09:48 PM

Document Has Been Signed on 03/21/2025 04:09 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GILBERT CARE HOME - LULLABYFACILITY NUMBER:
306004178
ADMINISTRATOR/
DIRECTOR:		ARNOLD C ANDALFACILITY TYPE:
735
ADDRESS:1512 W LULLABY LANETELEPHONE:
(714) 817-8983
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 6DATE:
03/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:52 PM
MET WITH:Eva Andal Care GiverTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Eva Andal. LPA Vanegas explained the purpose of the inspection, and began a tour of the facility and observed the following.

This is a one storied home with nine bedrooms, six of which are client rooms, two of which are staff rooms, and one of which is used for an office. There are three bathrooms two of which are shared client bathrooms, and one of which is for staff and visitors. LPA Vanegas observed kitchen area to be clean, and free of any debris and mildew. LPA Vanegas observed a gas stove, microwave, refrigerator, washer, and dryer all to be in good condition and operational. LPA Vanegas observed a two day supply of perishable food, and a seven day supply of non-perishable food, and a sufficient amount of emergency water for clients in care and staff on duty.

LPA Vanegas observed all smoke and carbon monoxide detectors to be in good repair and operational. LPA Vanegas observed all fire extinguishers to be up to date and fully charged. LPA Vanegas observed bathrooms to be clean and free of debris and mildew. LPA Vanegas observed water faucets, and toilets to be operational, and water tested between109.0 andn 111.0 degrees.

LPA Vanegas observed all client rooms to consist of required furnishings such as a chair, lamp, chest drawers, bed, and clean linens in good repair, meaning no strains or tears. LPA Vanegas observed no obstructions blocking entry ways to rooms, and rooms are large enough to walk about freely in respective client rooms. LPA Vanegas observed the outside of the facility to be clean, and large enough to participate in outdoor activities upon client request. There are no obstructions along emergency exit routes and side doors are self latching and unlocked.
CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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: GILBERT CARE HOME - LULLABY
FACILITY NUMBER: 306004178
VISIT DATE: 03/21/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Vanegas reviewed six client files, and six staff files, all files (staff and client) consisted of all required documents, and they were all documented correctly. Staff training is up to date and filed correctly. LPA Vanegas observed all toxins, sharps, and medications to be locked away and inaccessible to clients in care.

LPA Vanegas reviewed first aid kit, and it consisted of all required items such as adhesive tape, scissors, tweezers, bandages, a thermometer, and a first aid manual. LPA Vanegas reviewed P&I with Administrator (AD) Arnold Andal, and observed all balances to be accounted for and documented correctly. LPA Vanegas reviewed medications with AD, and observed all medications to be documented correctly. Per LPA Vanegs review all medications are being administered per physicians orders.

Based on observations made during today's inspection no deficiencies will be cited per title 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with AD Arnold Andal, and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2