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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605586
Report Date: 07/05/2024
Date Signed: 08/27/2024 12:59:20 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/27/2024 12:59 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:PEOPLE IN PROGRESS-JEFFERSONFACILITY NUMBER:
300605586
ADMINISTRATOR/
DIRECTOR:		DANE SYNDERFACILITY TYPE:
735
ADDRESS:5372 JEFFERSON RD.TELEPHONE:
(714) 646-9596
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 6CENSUS: DATE:
07/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On July 5, 2024 at 1:05pm, Licensing Program Analyst (LPA) Edward Kim attempted to conduct an unannounced required 1-Year annual visit using the CARE Inspection Tool. There was no one at the facility. LPA Kim contacted through telephone Staff Tim Gue to follow-up information on the facility. Facility had all clients moved out on June 26, 2024.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2024
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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