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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300604021
Report Date: 10/10/2023
Date Signed: 10/18/2023 12:38:44 PM

Document Has Been Signed on 10/18/2023 12:38 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:YMCA-EADER PROGRAM CENTERFACILITY NUMBER:
300604021
ADMINISTRATOR:SABEDRA-TAYLOR, MEGANFACILITY TYPE:
840
ADDRESS:9291 BANNING AVETELEPHONE:
(714) 968-3638
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 0DATE:
10/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director Andrea HillTIME COMPLETED:
04:15 PM
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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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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