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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002455
Report Date: 06/12/2024
Date Signed: 06/12/2024 03:27:23 PM

Document Has Been Signed on 06/12/2024 03:27 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:INDEPENDENT OPTIONS INC/ANACAPA HOUSEFACILITY NUMBER:
306002455
ADMINISTRATOR/
DIRECTOR:		BUTCH MALLILLINFACILITY TYPE:
735
ADDRESS:2538 ANACAPA DRIVE #105TELEPHONE:
(714) 556-2591
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 4CENSUS: 4DATE:
06/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Nolette UntalanTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Michael Tea made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for a deficiency issued on 06/07/2024 during the required annual inspection conducted by LPA Rosie Quiroz. LPA was greeted and granted entry by a direct service provider Madison Moore. The Administrator (AD), Nolette Untalan and Regional Director (RD), Leilani Whitfield arrived shortly after to assist during the visit. LPA discussed the purpose of the inspection with AD Untalan.

LPA Tea toured the facility to check the deficiency has been corrected with AD Untalan. A maintenance repair man was on site changing the water boiler with a brand new one at the time of today's visit. The cabinets in the kitchen have been repainted and resurfaced. The common areas and bedroom lighting fixtures have been replaced with new light bulbs and the common areas have new floor lamps.

Based on LPA Tea's observation on today's visit, the Plan of Corrections has been fulfilled by the assigned POC due date of 06/14/2024, thus clearing the Type B deficiency CCR 80088(d)(e)(1).

An exit interview was conducted with Administrator Nolette Untalan and a copy of this report was provided to the facility

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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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