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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306002915
Report Date:
02/28/2023
Date Signed:
02/28/2023 12:40:46 PM
Document Has Been Signed on
02/28/2023 12:40 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:
BROOKDALE ANAHEIM
FACILITY NUMBER:
306002915
ADMINISTRATOR:
TROY BYINGTON
FACILITY TYPE:
740
ADDRESS:
200 N DALE ST
TELEPHONE:
(714) 761-5771
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92801
CAPACITY:
140
CENSUS:
94
DATE:
02/28/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:15 AM
MET WITH:
TIME COMPLETED:
12:00 PM
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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver amended findings for complaint control number # 22-AS-20230106134321
.
LPA met with Executive Director Troy Byington and discussed the amended findings. An exit interview was conducted and a copy of this report as well as the amended findings were provided.
Due to technical difficulties. a copy of the reports were emailed to Troy Byington.
SUPERVISOR'S NAME:
Alisa Ortiz
TELEPHONE:
(714) 703-4084
LICENSING EVALUATOR NAME:
Andrea Mendivil
TELEPHONE:
714-703-2738
LICENSING EVALUATOR SIGNATURE:
DATE:
02/28/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/28/2023
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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