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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005226
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:03:23 PM


Document Has Been Signed on 12/13/2023 04:03 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: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: 43DATE:
12/13/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:48 PM
MET WITH:Darlene Lindley- AdministratorTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Jessica Cho continued the visit in conjunction with the delivery of the findings in connection to Complaint Control Number: 22-AS-20230919083629. LPA explained the reason for the POC visit to Administrator Darlene Lindley.

*Deficiency cited Title 22 Regulation 87355(e)(b)(1) Obtain a California clearance or a criminal record exemption as required by the Department. LPA received proof of clearance on September 29, 2023 at 2:18pm. The Administrator has complied with the POC and has been advised via this report to maintain compliance in the item cited on September 28, 2023.

An exit interview was conducted with Administrator Darlene Lindley, and a copy of this report including the Letter of Deficiency Citations Cleared were provided at the end of the visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023
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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