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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607404
Report Date: 10/15/2024
Date Signed: 10/15/2024 02:03:38 PM

Document Has Been Signed on 10/15/2024 02:03 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:LAURENCE RESIDENTIAL CAREFACILITY NUMBER:
300607404
ADMINISTRATOR/
DIRECTOR:		LAURENCE, VERNELLFACILITY TYPE:
735
ADDRESS:3722 S. ROSS ST.TELEPHONE:
(714) 662-7771
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 6CENSUS: 0DATE:
10/15/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:06 PM
MET WITH:Licensee Vernell LaurenceTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit to verify facility closure, and to ensure no clients were receiving care and supervision at the facility. LPA was greeted by Licensee Vernell Laurence. Staff Representative Patricia Ingram was present during visit.

LPA attempted annual inspection visit on 10/4/2024. Licensee was unavailable and mentioned they were closing facility.

Licensee informed LPA Tirre that last client's day on site was on September 26, 2024.

On today's date, LPA conducted a tour of the physical plant. LPA observed rooms were cleared out of personal belongings and was advised that the furniture will be staying at home. LPA observed Items packed in plastic bags and licensee stated these items were for donation. LPA observed no signs of clients and the facility in operation.



LPA requested the facility license as it is part of the closure process, and the license was surrendered during the visit. LPA informed the above facility representatives of the licensing procedure for future facility operation if desired.

Licensee has decided to permanently close the facility at this time. The Department will proceed with the closure as of October 15, 2024.

An exit interview was conducted with staff representative and a copy of the report was provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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