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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003934
Report Date: 09/20/2022
Date Signed: 09/20/2022 11:39:30 AM

Document Has Been Signed on 09/20/2022 11:39 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 3FACILITY NUMBER:
306003934
ADMINISTRATOR:ANICIA LOPEZFACILITY TYPE:
735
ADDRESS:1621 S. IVANHOE STREETTELEPHONE:
(714) 758-3655
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 5DATE:
09/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Alexander NavarroTIME COMPLETED:
12:00 PM
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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. LPA was check in via covid screening procedure. LPA met with Alexander Navarro and explained the nature of the visit.

LPA began the tour of the inside and outside of the facility. There are five clients in care and there are no active covis-19 cases in the facility. LPA observed clients throughout the facility. Clients appeared to be clean and well taken care of. LPA observed required department postings, covid-19 precautionary postings in the facility as well as hand washing signs throughout the facility. Staff conduct a check in covid screening upon entry and the facility is taking temperatures. The information is being documented and kept in records. All restrooms observed to be clean and have a supply of soap. LPA inspected the client’s bedrooms and they appeared to be clean and sanitary. All bedrooms observed to have all required components. Facility has a back up emergency food supply and water supply. The facility has an ample supply of PPE, this house is used as the central PPE storage for all of their homes. LPA toured the outside of the facility and observed a covered patio with seating for client’s enjoyment.

Based on the observation made during today’s visit, no deficiencies were noted today 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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