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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005226
Report Date: 10/26/2023
Date Signed: 10/26/2023 05:23:58 PM


Document Has Been Signed on 10/26/2023 05:23 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:ARBOR PALMS OF ANAHEIMFACILITY NUMBER:
306005226
ADMINISTRATOR:YOUNG PARKFACILITY TYPE:
740
ADDRESS:3411 W BALL RDTELEPHONE:
(714) 821-9660
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:130CENSUS: 66DATE:
10/26/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Darlene Lindley, Executive DirectorTIME COMPLETED:
05:30 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced Case Management visit to the facility to serve an Immediate Exclusion Order to staff member S1. LPA Saborit-Guasch met with Executive Director Darlene Lindley and explained the reason for the visit.

The Immediate Exclusion Order was explained to the facility administrator as well as to facility staff S1. They both stated they understood the Order and said they had no additional questions.

LPA Kevin Saborit-Guasch observed staff member S1 leaving facility with their possessions.

An exit interview was conducted, A copy of this report was left at the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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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