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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002954
Report Date: 12/13/2024
Date Signed: 12/13/2024 09:31:39 AM

Document Has Been Signed on 12/13/2024 09:31 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:BROOKDALE IRVINEFACILITY NUMBER:
306002954
ADMINISTRATOR/
DIRECTOR:		CARRIE GALLOWAYFACILITY TYPE:
740
ADDRESS:10 MARQUETTETELEPHONE:
(949) 854-3766
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY: 155TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
12/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Shannon HowellTIME VISIT/
INSPECTION COMPLETED:
09:42 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 Executive Director Shannon Howell.

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

An exit interview was conducted with the executive director Shannon Howell . A copy of this report and amended LIC9099, LIC9099C was provided to the facility.
Alisa OrtizTELEPHONE: (714) 287-4084
Michael TeaTELEPHONE: 714-703-2840
DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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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