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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607257
Report Date: 01/24/2023
Date Signed: 01/24/2023 03:25:10 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/24/2023 03:25 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:A.L. HOME CARE IIFACILITY NUMBER:
300607257
ADMINISTRATOR:AMANTE, LUZFACILITY TYPE:
735
ADDRESS:2322 W. CAMDEN PLACETELEPHONE:
(714) 432-1126
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY: 6CENSUS: 5DATE:
01/24/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Pearly Tamola
Ann Amante		TIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Continuation Annual Inspection. LPA was greeted by staff Pearly Tamola and granted entry into the facility. LPA Gutierrez discussed the purpose of the inspection. During the inspection LPA Gutierrez and staff Tamola conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:

This is a single-story house with three client bedrooms, two staff bedrooms and two bathrooms. During the inspection LPA observed one staff and five clients in care. Clients were observed resting in their respective rooms and returning from day program. Upon record review LPA noted emergency care requirements were met. LPA observed hallways and walkways were free of obstruction.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

Administrator (AD) Ann Amante arrived at 2:59 p.m. An exit interview was conducted, and a copy of this report was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023
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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