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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
300614068
Report Date:
09/05/2024
Date Signed:
09/06/2024 07:46:41 AM
Document Has Been Signed on
09/06/2024 07:46 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
ORANGE COUNTY CC RO
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
N.O.C. R.O.P. ANAHEIM HIGH SCHOOL
FACILITY NUMBER:
300614068
ADMINISTRATOR/
DIRECTOR:
CLARK, MARY
FACILITY TYPE:
850
ADDRESS:
811 W. LINCOLN, ROOM #170
TELEPHONE:
(714) 956-5640
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92805
CAPACITY:
24
TOTAL ENROLLED CHILDREN:
24
CENSUS:
DATE:
09/05/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:
TIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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SUPERVISORS NAME
:
Thuy Ho
LICENSING EVALUATOR NAME
:
Cynthia Sun
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/05/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/05/2024
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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