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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306003594
Report Date:
10/24/2024
Date Signed:
10/24/2024 01:41:28 PM
Document Has Been Signed on
10/24/2024 01:41 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:
LOIS GUEST HOME II
FACILITY NUMBER:
306003594
ADMINISTRATOR/
DIRECTOR:
MARICEL WRIGHT
FACILITY TYPE:
740
ADDRESS:
17562 MEDFORD AVENUE
TELEPHONE:
(714) 573-7697
CITY:
TUSTIN
STATE:
CA
ZIP CODE:
92780
CAPACITY:
6
CENSUS:
5
DATE:
10/24/2024
TYPE OF VISIT:
POC
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:09 PM
MET WITH:
Lilliosa Manelli
TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 10/01/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit.
At 1:15 PM LPA toured the facility and observed the following:
Deficiency cited under Title 22 Regulation 87303(e)(2) pertaining to water temperature has been cleared. LPA tested water temperature to be between 118.7 and 120 F degrees. Licensee has complied with the POC.
Deficiency cited under Title 22 Regulation 87303(a) pertaining to maintenance and operation has been cleared. LPA observed the wall in the jack and jill restroom has been repaired. Licensee has complied with the POC.
Licensee has been advised to maintain compliance in things previously cited.
Exit interview conducted and a copy of this report was left at the facility
SUPERVISORS NAME
:
Alisa Ortiz
LICENSING EVALUATOR NAME
:
Kimberly Lyman
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/24/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/24/2024
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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