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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003935
Report Date: 09/29/2022
Date Signed: 09/29/2022 03:29:28 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/29/2022 03:29 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 4FACILITY NUMBER:
306003935
ADMINISTRATOR:ANICIA LOPEZFACILITY TYPE:
735
ADDRESS:2002 W. CHATEAU AVENUETELEPHONE:
(714) 563-0617
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 0DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Martin LopezTIME COMPLETED:
03:45 PM
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On 09/29/2022 at 2:19pm, Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced visit to Chateau St. Mark Homes 4. The purpose of today's visit was to conduct a Required 1 Year focusing primarily on the Infection Control. At 2:25pm, LPA Cho approached the facility and rang the doorbell three times and there was no response. LPA looked through the window and there was no activity inside and outside the facility. LPA contacted the facility telephone number, and LPA heard the fax line. LPA contacted the mobile number of Administrator (Admin) Martin Lopez at 2:27pm and at 2:32pm and left two voice messages requesting a call back. Admin Lopez returned the call at 2:45pm and arrived around 2:55pm. Per the interview, Admin stated the following:

The facility closed approximately 01/2022 due to a lack of clients and has not accepted any clients since. Admin indicated that the facility will take this opportunity to renovate and to focus on "filling in the empty beds" in other facilities operated by Licensee Anicia Lopez. Admin indicated that there are no dates on accepting new clients.

As of today, there are no clients living in the facility. LPA conducted a tour along with Admin Lopez. LPA did not measure the hot water temperature due to the gas being turned off. Admin was advised to inform the LPA when the facility is ready to accept new clients and was reminded to pay the annual licensing fees to keep the license active.

Based on the observations made during today's visit, no deficiency is cited in this review as per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Martin Lopez, and a copy of this report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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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