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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005447
Report Date:
08/16/2022
Date Signed:
08/16/2022 01:13:42 PM
Document Has Been Signed on
08/16/2022 01:13 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:
LAMBERT HOME CARE
FACILITY NUMBER:
306005447
ADMINISTRATOR:
ASAWADILO, YANINEE
FACILITY TYPE:
740
ADDRESS:
8191 LAMBERT DRIVE
TELEPHONE:
(714) 848-1982
CITY:
HUNTINGTON BEACH
STATE:
CA
ZIP CODE:
92647
CAPACITY:
6
CENSUS:
4
DATE:
08/16/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:19 AM
MET WITH:
Administrator Yaninee Asawadilo
TIME COMPLETED:
10:15 AM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced case management visit in conjunction with follow up Case Management visit on 8/1/2022. LPA were granted entry by staff. LPA identified themselves and discussed purpose of the visit with Administrator Yaninee Asawadilokchai.
During visit LPA Tirre toured facility plant. During visit LPA observed that medications were locked in a secured closet. LPA observed there was no pre poured medications inside closet. LPA cleared deficiencies from previous case management.
A exit interview was conducted with Administrator and a copy of this report along with Cleared POC letter was provided to facility.
SUPERVISORS NAME
:
Alisa Ortiz
LICENSING EVALUATOR NAME
:
Jenifer Tirre
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/16/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/16/2022
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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