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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370908
Report Date: 08/27/2019
Date Signed: 09/10/2019 03:23:46 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:ACDC AT GRACE LUTHERANFACILITY NUMBER:
304370908
ADMINISTRATOR:LOWE, KELLIEFACILITY TYPE:
830
ADDRESS:700 WEST SOUTH STREETTELEPHONE:
(714) 956-9611
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:21CENSUS: 0DATE:
08/27/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kellie Lowe-DirectorTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Taylor arrived at the facility to conduct a Random/Annual inspection. LPA Taylor met with Kellie Lowe the Director of the school. The Director informed LPA Taylor the school was closed today and there were no children present. The Director requested LPA walk the facility today for input on the set up of the classrooms.

LPA Taylor toured the facility with the Director on this day.

LPA Taylor will return to complete Random/Annual inspection at a later date when the school is open and has children present.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.



Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Appeal rights provided and explained. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019
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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