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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606032
Report Date: 10/25/2021
Date Signed: 10/25/2021 11:28:07 AM

Document Has Been Signed on 10/25/2021 11:28 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:JASMINE GARDENFACILITY NUMBER:
300606032
ADMINISTRATOR:HALAHAN, ELIZABETHFACILITY TYPE:
735
ADDRESS:1329 N. JASMINE ST.TELEPHONE:
(714) 776-8582
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 8CENSUS: 2DATE:
10/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Gisela Montalvo TIME COMPLETED:
11:44 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. Facility is a 6 bedroom house with 4 bathrooms and a two car detached garage. One bedroom is for staff. Capacity is for 8 clients. Facility currently has 7 clients, 2 clients were at the facility during the visit. All smoke detectors and carbon monoxide detectors tested operational. All fire extinguishers are fully charged. LPA and staff toured the facility. All bedrooms were clean and had the required furniture. All of the bathrooms were clean and operational. The kitchen was clean and organized. The knives and chemicals are kept locked and inaccessible to clients. LPA observed a 2 day supply of perishable food and a 7 day supply of non-perishable food on hand. Medication is kept locked in a cabinet. The garage is kept secured and is used for storage. Extra food and supplies are kept in the garage. The backyard has an exit gate that is operational. No bodies of water observed. No obstacles or hazards observed inside or outside of the facility. LPA inspected the first aid kit. First aid kit had the required elements. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2021
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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