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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000049
Report Date: 09/05/2024
Date Signed: 09/05/2024 10:12:46 AM

Document Has Been Signed on 09/05/2024 10:12 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HALL FAMILY HOMEFACILITY NUMBER:
306000049
ADMINISTRATOR/
DIRECTOR:		RON SALDAFACILITY TYPE:
735
ADDRESS:1922 WEST FLORA STREETTELEPHONE:
(714) 434-0100
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY: 6CENSUS: 0DATE:
09/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:57 AM
MET WITH:Diane Hall-LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:27 AM
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On this day Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an unannounced Plan of Correction (POC) visit in conjunction with citation issued on August 15, 2024. LPA was greeted and granted entry into the facility by Licensee Diane Hall and explained the reason for the visit.

As of 09/05/24 Deficiency cited under Title 22 Regulation 80087(a) pertaining to Building and Grounds has been CLEARED.

Licensee cleaned and repaired the kitchen and bathrooms areas. Licensee has complied with the terms of the POC.

LPA Ramirez conducted an exit interview with Licensee Hall and a copy of this report and Letter of Cleared Deficiency has been provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
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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