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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306004574
Report Date:
10/09/2023
Date Signed:
10/09/2023 04:11:24 PM
Document Has Been Signed on
10/09/2023 04:11 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 ASC
,
770 THE CITY DR., SUITE 7100
ORANGE
,
CA
92868
FACILITY NAME:
BREWSTER HOME
FACILITY NUMBER:
306004574
ADMINISTRATOR:
EVELYN PASCUAL
FACILITY TYPE:
735
ADDRESS:
1237 W. BREWSTER AVE.
TELEPHONE:
(714) 535-3976
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92801
CAPACITY:
6
CENSUS:
DATE:
10/09/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:49 AM
MET WITH:
TIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility at 11:40am to conduct a required annual inspection. LPA was not greeted after ringing the doorbell and knocking. LPA called the facility's phone but no one answered. LPA called the facility again at 11:55am. Administrator (AD) Edguardo Pascual answered the phone. AD stated that most clients were at day program and that he had to take one client to an appointment. AD stated they would return to the facility before 1:00pm.
LPA departed the facility.
SUPERVISORS NAME
:
Armando J Lucero
LICENSING EVALUATOR NAME
:
Dwayne L Mason
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/09/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/09/2023
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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