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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000049
Report Date: 06/21/2022
Date Signed: 06/21/2022 12:05:56 PM

Document Has Been Signed on 06/21/2022 12:05 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:HALL FAMILY HOMEFACILITY NUMBER:
306000049
ADMINISTRATOR:RON SALDAFACILITY TYPE:
735
ADDRESS:1922 WEST FLORA STREETTELEPHONE:
(714) 434-0100
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY: 6CENSUS: 3DATE:
06/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Maria SotoTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Lydia Martinez made this unannounced Case Management visit in conjuction with facilitiy's Required 1-Year annual for the purpose of discussing facilities annual fees that are over due. LPA was granted entry by Staff Maria Soto.

Facility's annual fees have not been paid since June 2020 and are past due and it is imperative that annual fees and late fees be paid as soon as possible to avoid the forfeiture of the license. In an effort to assist with the payment, LPA provided a copy of "Facility Transaction History, which contains PIN number, and can be used to pay the balance immediately at CCLD's website http://www.ccld.ca.gov/.

Administrator Salda is to follow up and let LPA know when fees have been paid.

No deficiencies are being cited per Title 22, Division 6, of the California Code of Regulations. LPA reviewed this report with Staff Soto and a copy of this report was emailed during this visit. Copy of Transaction History was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2022
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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