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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003734
Report Date: 03/28/2024
Date Signed: 03/28/2024 09:29:42 AM

Document Has Been Signed on 03/28/2024 09:29 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:JAIRE HOME IFACILITY NUMBER:
306003734
ADMINISTRATOR:LOUISE IGISAIARFACILITY TYPE:
735
ADDRESS:800 LA REINA STREET, N.TELEPHONE:
(714) 995-5575
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 6DATE:
03/28/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Louise Igisaiar- AdministratorTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose to clear the deficiency cited on March 14, 2024 from 9:38am -10:30am.

*Deficiency cited under Title 22 Regulations 80019 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) "Request a transfer of a criminal record clearance..."

Facility has complied with the terms of the plan of correction on March 15, 2024 at 12:19pm. The deficiency is now cleared.

An exit interview was conducted with Administrator Louise Igisaiar, and a copy of this letter including the Letter of Deficiency Citations Cleared were provided at the end of the visit.


SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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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