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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005331
Report Date: 06/28/2024
Date Signed: 06/28/2024 03:57:33 PM

Document Has Been Signed on 06/28/2024 03:57 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:MEGAN CARE HOMES/OMA PLACEFACILITY NUMBER:
306005331
ADMINISTRATOR/
DIRECTOR:
JACINTO, ASUNCIONFACILITY TYPE:
735
ADDRESS:1501 S ROOSEVELT AVETELEPHONE:
(714) 588-3112
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 4CENSUS: 4DATE:
06/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Anil Suresh, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation and Case Management Follow-up. LPA was greeted and granted entry by Evangeline Cayton, Direct Support Professional (DSP). During today’s visit, LPA met with Anil Suresh, Licensee (LE).

During today's visit LPA asked DSP staff on the status of Client 4 (C4) who was at Day Program at time of arrival. An Unusual Incident Report was received by our office on June 27, 2024 stating C4 had been in a motor vehicle accident while being transported to Day Program by the Job Coach. C4 was immediately taken to hospital for evaluation and received stitches for laceration on ear and was released later that afternoon. (Please see LIC 858 for C4 information).

Upon C4's return from Day Program, LPA engaged with client who assented with a head nod that she was okay. C4 was observed playing with flash cards at the dining room table with another client. Based on LPA's observations and interview with C4, the client is been medically treated and back to a daily routine.

An exit interview was conducted with Anil Suresh, LE and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
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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