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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605586
Report Date: 08/29/2024
Date Signed: 08/29/2024 03:20:44 PM

Document Has Been Signed on 08/29/2024 03:20 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: 0DATE:
08/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Roger Timothy GueTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On August 29, 2024, at 2:15pm, Licensing Program Analyst (LPA) Edward Kim conducted a case management visit to verify facility closure. LPA Kim met with Assistant Administrator Roger Timothy Gue to verify facility ceased operation and to obtain the surrendered license. The AA stated that the license was destroyed. LPA Kim reprinted a license and obtained AA’s signature confirming facility closure. LPA Kim conducted a walk through with AA Gue and verified there are no residents and signs of operation. AA submitted the letter of intent to close the facility on August 29, 2024 and the residents’ last day was on June 26, 2024.

The location is under escrow and will no longer function as an Adult Residential Facility. Based on the observation and interviews, the facility is now closed. The Department will proceed with the closure as of June 26, 2024. LPA Kim informed the above facility representatives of the licensing procedure for future facility operation if desired.

An exit interview was conducted with Assistant Administrator Roger Timothy Gue, and a copy of this report was provided at the end of the report.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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