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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004435
Report Date: 12/23/2024
Date Signed: 12/23/2024 03:43:19 PM

Document Has Been Signed on 12/23/2024 03:43 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:STONYBROOK RESIDENTAL CARE IFACILITY NUMBER:
306004435
ADMINISTRATOR/
DIRECTOR:		BRANDON PENALOSAFACILITY TYPE:
735
ADDRESS:9542 STONYBROOK DRIVETELEPHONE:
(657) 208-1902
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 5CENSUS: 5DATE:
12/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:House Manager- Maria Gladys FramoTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On December 23, 2024, at 1:30pm, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced Case Management Visit to follow-up on deficiencies cited in forms LIC809D on May 22, 2024. LPA Kim was greeted and granted entry by House Manager (HM) Maria Gladys Framo. HM Framo called Administrator (AD) Brandon Penalosa over the phone and LPA explained the purpose of the visit. AD Penalosa informed LPA Kim that HM Framo could sign on his behalf for the report.

LPA Kim and HM Framo toured the physical plant and made the following observations.

Deficiency cited under Title 22 Regulation California Regulation Codes (CRC) 80026(h) pertaining to safeguard for cash resources has been cleared. AD Penalosa completed LIC855 and LIC9098 indicating they have read and understood the deficiency. AD Penalosa states they are working with the day program to ensure the clients return with all receipts.

Deficiency cited under Title 22 Regulation CRC 80087(a) pertaining to facility being safe, clean, sanitary, and in good repair has been cleared. LPA Kim observed the dresser knob in Client Room#1, the dresser handle in Client Room #4, and the peeling plaster in the bathroom #2 windowsill were all fixed and operational.

Licensee has been advised to maintain all items especially those that were previously deficient in the facility in accordance with Title 22 Regulations.

An exit interview was conducted, and a copy of this report and two POC Clearance letters were provided to House Manager Maria Gladys Framo
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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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