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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005412
Report Date: 05/20/2024
Date Signed: 05/20/2024 04:00:25 PM

Document Has Been Signed on 05/20/2024 04:00 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:AMHS TELECARE TREEHOUSE CRISIS RESIDENTIAL NORTHFACILITY NUMBER:
306005412
ADMINISTRATOR/
DIRECTOR:
JAQUELINE LARAFACILITY TYPE:
772
ADDRESS:2026 W.BEACON AVENUETELEPHONE:
(657) 276-7030
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 4DATE:
05/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Jaqueline Lara - Program ManagerTIME VISIT/
INSPECTION COMPLETED:
04:16 PM
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Licensing Program Analysts (LPAs) Dwayne Mason Jr. and Michael Tea conducted an unannounced visit for the purpose of conducting a required annual inspection. LPAs were greeted and granted entry into facility by Nageen Bibi, Residential Counselor. LPAs met with Jaqueline Lara, Program Administrator and explained the nature of the inspection.

The facility is a one-story home with three client bedrooms, two bathrooms, kitchen, dining room, living room, two offices, medication room, backyard with pool and attached two car garage. Facility appears clean, sanitary and organized. All client rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured at 111 degrees Fahrenheit in the common bathroom and 118.5 degrees Fahrenheit in the clinician office with medication storage. LPA observed facility has emergency food and water supply stored in the garage. Carbon Monoxide/Smoke Detectors were tested and operational. Fire Extinguishers were fully charged as indicated by the arrow pointing in the green zone. Service tags indicated the extinguishers were last serviced on December 23, 2023. Medication for each resident is kept in the medication storage in the clinician office. The backyard has one shaded seating area and a pool. The pool is surrounded on two sides by an 8-foot-tall brick wall. The other two sides are surrounded by an iron fence. The fence is 5 feet tall and the bottom of the fence is 2.25 inches off the ground. The fence has vertical bars that are separated by 3.5 inches of space. The facility has activity supplies including but not limited to: puzzles, games, books, arts and crafts, exercise equipment and a full activity calendar. Exit gates are unlocked and self latching. LPAs reviewed three client files and three staff files. LPAs interviewed one client and one staff.

No deficiencies were noted during today's visit. An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2024
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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