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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003933
Report Date: 09/20/2022
Date Signed: 09/20/2022 09:50:44 AM

Document Has Been Signed on 09/20/2022 09:50 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CHATEAU ST. MARK HOMES 1FACILITY NUMBER:
306003933
ADMINISTRATOR:ANICIA LOPEZFACILITY TYPE:
735
ADDRESS:9671 RANDOM DRIVETELEPHONE:
(714) 635-7732
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 5DATE:
09/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Teresita RingorTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by caregiver and LPA explained the nature of the visit. LPA spoke with Martin Lopez, Administrator via telephone call.

LPA Martinez began the tour of the inside and outside of the facility. There are five clients in care and there are no active covid-19 cases in the facility. LPA observed five clients throughout the facility doing activities. All clients appeared to be clean and well taken care of. LPA observed required Department postings, covid-19 precautionary postings as well as hand washing signs throughout the facility. All restrooms observed to have a supply of soap and appeared to be clean. LPA inspected client’s bedrooms and they appeared to be clean and sanitary. All bedrooms observed to have all required components. The facility has three private bedrooms and one shared bedroom. LPA observed a check in station. The facility is taking temperatures and documenting the results. The facility has a supply of emergency food and water supply in the attached garage. The PPE supply is stored in storage cabinet in the dining room. Medication is stored and locked in a storage cabinet in dinning room. LPA toured the outside of the facility and observed shaded seating areas for the client’s enjoyment. The facility has a gated pool inaccessible to clients in care.

Based on the observation made during today’s visit, no deficiencies were noted in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the facility representative and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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