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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004689
Report Date: 02/29/2024
Date Signed: 02/29/2024 08:59:43 AM

Document Has Been Signed on 02/29/2024 08:59 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:
02/29/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sarah Pinero
Odilon Pinero		TIME COMPLETED:
09:15 AM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced Plan of Correction (POC) inspection for the purpose of clearing deficiency previously cited during POC inspection on 2/22/24. LPA was greeted and granted entry by Staff Odilon Pinero. LPA met with House Manager (HM) Sarah Pinero and explained the purpose of the inspection.

Deficiency previously cited during required annual inspection on 2/01/24, was due to kitchen windowsill dripping water above an electrical outlet, as water leaked through the window frame from the rain outside. On 2/09/24, LPA conducted on unannounced POC inspection, and observed the window frame and windowsill had not been repaired. LPA spoke with Licensee by phone, who stated the window would be replaced entirely and the new window had been ordered the day prior. Per Licensee, they anticipated the window would be replaced the following week and requested a two week extension. LPA informed Licensee an additional unannounced inspection would be conducted at the time. Licensee stated they understood.

During POC visit on 2/22/24, LPA observed window frame and windowsill had not been repaired. At approximately 11:20 a.m. LPA spoke with Administrator (AD) Dexter Dizon by phone, who stated window had not arrived and they did not have an anticipated date for when repairs would take place; Deficiency was re-cited.

During today's inspection, LPA observed the window had been replaced and sealed; Deficiency is cleared.

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: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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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