<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
300611137
Report Date:
10/18/2021
Date Signed:
10/18/2021 01:12:02 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
BARBUTO, SALLY ANN
FACILITY NUMBER:
300611137
ADMINISTRATOR:
BARBUTO, SALLY ANN
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(714) 525-8056
CITY:
FULLERTON
STATE:
CA
ZIP CODE:
92832
CAPACITY:
14
CENSUS:
5
DATE:
10/18/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:05 PM
MET WITH:
Sally Ann Barbuto, Licensee
TIME COMPLETED:
01:15 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
This is an unannounced Case Management Inspection for the purpose to provide a respond to the letter received from Licensee Sally Barbuto. On today's inspection a duplicate report of the Complaint Investigation Report is being issued to Licensee.
SUPERVISOR'S NAME:
Rina Lopez
TELEPHONE:
(714) 703-2808
LICENSING EVALUATOR NAME:
Mila Quinto
TELEPHONE:
(714) 293-6471
LICENSING EVALUATOR SIGNATURE:
DATE:
10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/18/2021
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
1