<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004689
Report Date: 02/09/2024
Date Signed: 02/09/2024 10:41:38 AM

Document Has Been Signed on 02/09/2024 10:41 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:JIDDE RESIDENTIAL HOME IIIFACILITY NUMBER:
306004689
ADMINISTRATOR:DEXTER DIZONFACILITY TYPE:
735
ADDRESS:3127 W. TYLER AVENUETELEPHONE:
(714) 828-9637
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 4DATE:
02/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Sarah PineroTIME COMPLETED:
10:55 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced Plan of Correction (POC) visit for the purpose of following up regarding deficiency cited during annual required inspection on 2/01/24. LPA was greeted and granted entry by House Manager (HM) Sarah Pinero and explained the purpose of the inspection.

Deficiency previously cited was due to kitchen windowsill dripping water above an electrical outlet, as water leaked through the window from the rain outside. On 2/01/24, Administrator (AD) Dexter Dizon provided LPA with a copy of roof assessment and appointment for repairs via email. During today’s inspection, LPA observed the window and windowsill had not been repaired. At 10:10 a.m. LPA spoke with Licensee by phone, who stated the window will be placed entirely and new window was ordered yesterday. Per Licensee, they anticipate window will be replaced next week. LPA informed Licensee an additional unannounced inspection will be conducted at the time. Licensee stated they understood.

Based on today’s observations, 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 left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1