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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001666
Report Date: 11/16/2023
Date Signed: 11/16/2023 12:49:33 PM

Document Has Been Signed on 11/16/2023 12:49 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:EMPOWER COMMUNITY DAY PROGRAMFACILITY NUMBER:
306001666
ADMINISTRATOR:MICHAEL J. MURPHYFACILITY TYPE:
775
ADDRESS:8381 KATELLA AVE. STE C,D, & ETELEPHONE:
(310) 902-2562
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY: 72CENSUS: 64DATE:
11/16/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Michael Murphy- Administrator TIME COMPLETED:
01:05 PM
NARRATIVE
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On this day Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced visit to conduct a case management. LPA was greeted and granted entry by Administrator Michael Murphy and explained the reason for the visit.

The Immediate Exclusion Order was explained to Administrator Michael Murphy. Administrator Michael Murphy understood the Immediate Exclusion Order. During visit LPA Mendivil observed Administrator Murphy disassociate Staff Yulizan Balce

While at the facility LPA Mendivil served Immediate Exclusion Order to Yulizan Balce. LPA Mendivil served Immediate Exclusion Order for the following facilities: Empower Community Day Program (306001666), VA&C Homes/ San Rafael (3060005388), VA&C Homes/ Bridgeport (306005385), VA&C Homes/San Paco Circle (306005930) VA&C Homes/Teranimar (306005931),and Stonybrook Residential (306004436).

All parties understood the Immediate Exclusion Order, and there were no additional questions.

LPA Mendivil observed Staff Yulizan Balce leave the facility with their possessions.

An exit interview was conducted with Administrator Michael Murphy.

A copy of this report was provided and explained.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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