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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004676
Report Date: 02/25/2025
Date Signed: 02/25/2025 04:40:17 PM

Document Has Been Signed on 02/25/2025 04:40 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:SHERCON GUEST HOMESFACILITY NUMBER:
306004676
ADMINISTRATOR/
DIRECTOR:		CONSOLACION LUMAUIGFACILITY TYPE:
740
ADDRESS:13432 GALWAY STREETTELEPHONE:
(714) 815-9214
CITY:GARDEN GROVESTATE: CAZIP CODE:
92844
CAPACITY: 6CENSUS: 6DATE:
02/25/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:46 PM
MET WITH:Connie Lumauig- Administrator/Licensee TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit in conjuction with complaint control #22-AS-20250218161612.

LPA Mendivil observed AD grab unsecured medications for Resident #1 from the refrigerator. AD stated they have a lock box in the refrigerator, and could not provide a reason.

During the course of the investigation Administrator Connie stated Staff 1 (S1) had not completed their background clearance and worked at the facility on 2/21/2025

Administrator stated S1 has not worked at the facility since 2/21/2025.


Based on observations and interviews made during today's visit the following is being cited per Title 22. An exit interview was conducted and a copy of this report was provided.


SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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
Document Has Been Signed on 02/25/2025 04:40 PM - It Cannot Be Edited


Created By: Andrea Mendivil On 02/25/2025 at 03:54 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SHERCON GUEST HOMES
FACILITY NUMBER: 306004676

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2025
Section Cited
CCR
87355(e)(2)

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(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)
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AD stated employee is not working and will not work until background check and association is completed.
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This requirement was not met evidence by S1 not associated to the facility. This poses an immediate health and safety threat to persons in care.
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Type A
02/26/2025
Section Cited
CCR87465(h)(2)

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(h) The following requirements shall apply to medications which are centrally stored: (2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
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Corrected during visit, AD placed medication in lockbox in the refridgerator.
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This requirement was not met as evidence by LPA observed AD remove unsecured medication from the refrigerator. This poses an immediate health and safety risk to persons 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:Alisa Ortiz
LICENSING EVALUATOR NAME:Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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