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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002275
Report Date: 03/04/2025
Date Signed: 03/04/2025 10:31:48 AM

Document Has Been Signed on 03/04/2025 10:31 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:ANGELS HOMEFACILITY NUMBER:
306002275
ADMINISTRATOR/
DIRECTOR:		RAFAEL A. TORRESFACILITY TYPE:
735
ADDRESS:12061 LORALEEN STREETTELEPHONE:
(714) 537-3413
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 6CENSUS: 3DATE:
03/04/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Ben PacquingTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today's visit was to conduct a case management. LPA Tea was greeted and granted entry into the facility by Direct Staff Personnel (DSP) Ben Pacquing.

On this day LPA Tea amended LIC9099, LIC9099C and LIC9099D dated 09/13/2024. LPA reviewed amended report with Executive Director.

An exit interview was conducted with the Administrator Rafael Torres. A copy of this report and amended LIC9099, LIC9099C was provided to the facility

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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