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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005195
Report Date: 08/15/2024
Date Signed: 08/15/2024 03:09:59 PM

Document Has Been Signed on 08/15/2024 03:09 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:EMBASSY RESIDENTIAL CARE IIFACILITY NUMBER:
306005195
ADMINISTRATOR/
DIRECTOR:		KON, CORAFACILITY TYPE:
735
ADDRESS:1621 E SANTA ANA STREETTELEPHONE:
(714) 732-7217
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 6CENSUS: 5DATE:
08/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Cora KonTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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Licensing Program Analysts (LPAs) Claudia Gutierrez and William Vanegas made an unannounced case management visit for the purpose of following-up regarding facility renovations. LPAs were greeted and granted entry by Administrator (AD) Cora Kon and the purpose of the inspection was explained.

During today’s visit, LPAs and AD conducted a tour of the facility. Per AD, renovations consisted of remodeling the kitchen and bathroom, including kitchen cabinets, counter tops, appliances, bathroom vanity, and flooring being replaced. LPAs observed the facility to have new flooring throughout, and in the clients' bedrooms. Kitchen and bathroom renovations have also been completed. LPAs observed facility structure continues to match the original facility sketch and fire clearance. Appliances and smoke detectors were observed to be operable. Water temperature tested at 108.1 degrees Fahrenheit.

Per AD, all clients will be returning to the facility today following day program as renovations have been completed. LPAs observed clients and facility staff arriving to the facility at the end of the inspection.

Based on 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 provided to AD.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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