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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000801
Report Date: 08/03/2023
Date Signed: 08/03/2023 11:17:00 AM

Document Has Been Signed on 08/03/2023 11:17 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CHAPMAN BOARD & CAREFACILITY NUMBER:
306000801
ADMINISTRATOR:BRYSON NAZARENOFACILITY TYPE:
735
ADDRESS:10811 CHAPMAN AVE.TELEPHONE:
(714) 638-8777
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 49CENSUS: 49DATE:
08/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Helen Balbalang- House ManagerTIME COMPLETED:
11:30 AM
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On today's date, Licensing Program Analyst (LPA) Jessica Cho made an unannounced case management visit for the purpose of delivering an amended report for a visit conducted on July 7, 2023 from 9:40-10:30am in connection to Complaint Control #: 22-AS-20230526163319.

During today's visit, LPA Cho met with House Manager (HM) Helen Balbalang and discussed the purpose of the visit. The initial report was delivered on July 7, 2023. LPA reviewed the amended report with HM and addressed the changes on the amended report and concerns and/or questions regarding the amendment of the report. LPA retrieved the initial report during the visit.

An exit interview was conducted with House Manager Helen Balbalang with the consent of Administrator Christopher Nazareno, and a copy of this report along with the amended complaint report (LIC9099/LIC9099-C) were provided at exit.



SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
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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