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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 01:38:01 PM

Document Has Been Signed on 08/16/2022 01:38 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 CAREFACILITY NUMBER:
306005447
ADMINISTRATOR:ASAWADILO, YANINEEFACILITY TYPE:
740
ADDRESS:8191 LAMBERT DRIVETELEPHONE:
(714) 848-1982
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 6CENSUS: 4DATE:
08/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator Yaninee AsawadiloTIME COMPLETED:
11:00 AM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced case management visit to follow up on incident reports in conjunction with complaint 22-AS-20220711084817. LPA was granted entry by staff. LPA discussed purpose of the visit with Administrator Yaninee Asawadilokchai.

On 8/3/2022 department received LIC 624 from facility regarding two incidents involving Resident's medications (R1). On 7/21/2022 Administrator stated that R1's Responsible Party told caregiver they wanted to look at R1's meds to discuss meds with Nurse Practitioner that had scheduled visit at Facility. According to Administrator Caregiver (CG1) opened medication closet and took out R1's box of meds and R1's Responsible Party took five bubble packs from box and went to R1's room. Upon leaving R1's room CG1 asked R1's Responsible party for bubble packs back. Administrator stated that Responsible party told CG1 "no", at this point Administrator arrived at facility and claims they explained to R1's Responsible party they cant take meds. Administrator stated that Responsible party left the facility with medications in bubble packs. Administrator called police to make a theft report.

On 7/26/2022 another incident happened where R1 came back to facility from an outing with Responsible party. Upon arrival Caregiver (CG2) popped out night meds from bubble pack and placed in med cup to give to R1. Administrator stated that R1's Responsible party took a capsuled medication which was bent and requested for a new capsule, CG2 popped out another medication and gave to R1. CG2 asked for bent capsule back and R1's responsible party refused to give back medication. CG2 and responsible party got into a verbal disagreement about medications and left facility.

Based on the information provided during today's visit, the following violations are being cited per California Code of Regulations Title 22.

CONTINUED ON 809C
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
VISIT DATE: 08/16/2022
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LPA Tirre discussed with Administrator/Licensee Yaninee Asawadillo department will be calling Licensee in for a Informal meeting to discuss being out of compliance.


An exit interview was conducted and a copy of this report along with appeal rights were left at the 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
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/16/2022 01:38 PM - It Cannot Be Edited


Created By: Jenifer Tirre On 08/16/2022 at 12:30 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: LAMBERT HOME CARE
FACILITY NUMBER: 306005447

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/17/2022
Section Cited
CCR
87465(h)(2)

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Incidental Medical and Dental services. 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. This requirement is not being met as evidenced by:
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Licensee to ensure residents medications to be centrally stored and not accessible to persons other than employees. Administrator agrees to secure all medications at all times. Administrator to read section cited, conduct inservice training with staff and submit written understanding and training to CCL by 8/17/22
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Based off information provided Licensee failed to ensure medications are inaccessible to persons other than employees. This poses an immediate health and safety risk to residents 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:Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2022


LIC809 (FAS) - (06/04)
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