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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370498
Report Date: 05/23/2022
Date Signed: 05/23/2022 09:13:30 AM


Document Has Been Signed on 05/23/2022 09:13 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:SANTA ANA CHILD DEVELOPMENT CENTER-EAST CAMPUSFACILITY NUMBER:
304370498
ADMINISTRATOR:GONZALEZ, ZEFERINAFACILITY TYPE:
850
ADDRESS:1510 NORTH PARTON STREETTELEPHONE:
(714) 480-7548
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:75CENSUS: 0DATE:
05/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Zeferina Gonzalez, AdministratorTIME COMPLETED:
09:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced case management visit as a result of information provided by Licensee Rep, Ms. Linnell. Upon arrival at facility LPA was unable to gain entrance and contacted licensee Rep Ms. Linnell who advised LPA that the facility was closed effective Thursday 05/19/22 and all items have been removed. LPA was also advised they have a pending application. LPA advised she needed to conduct walk through and have facility surrender license. Ms. Zeferina Gonzalez arrived later to assist LPA.
LPA was granted access and conducted walk through. The furniture, equipment and supplies have been removed and noted No children in care.

Ms. Gonzalez states the last day of providing services was April 1, 2022 and on May 19, 2022 all items were removed.

LPA was given copy of license facility . Facility is no in operation.

An exit interview was conducted Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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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