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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003933
Report Date: 10/03/2023
Date Signed: 10/03/2023 12:01:34 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/03/2023 12:01 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: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: 0DATE:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Martin LopezTIME COMPLETED:
12:15 PM
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Martin Lopez and discussed the purpose of the inspection.

During the inspection, LPA and AD toured the facility observed the following. There is extensive construction taking place at the facility. There are no clients or staff. There is no furniture or food. The water, gas, and electricity are currently running. Per AD, there were 5 clients at the facility who were all relocated around 05/20/23 to CHATEAU ST. MARK HOMES 4 (306003935) while the construction was taking place. AD estimates the construction will be completed in approximately 2 weeks. After that, the facility will be re-furnished and made ready for the clients’ return. AD estimates the clients will be able to return to the facility in approximately 1 month. LPA advised AD to notify LPA once the construction is completed.

There were no deficiencies observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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