306005412-4-15-2026-22-AS-HGOH-DT6V42-20260415160536

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005412
Report Date: 04/15/2026
Date Signed: 04/15/2026 04:05:48 PM

Document Has Been Signed on 04/15/2026 04:05 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:	AMHS TELECARE TREEHOUSE CRISIS RESIDENTIAL NORTH		FACILITY NUMBER:	306005412
ADMINISTRATOR/ DIRECTOR:	JAQUELINE LARA		FACILITY TYPE:	772
ADDRESS:	2026 W.BEACON AVENUE		TELEPHONE:	(657) 276-7030
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY: 6		CENSUS: 4	DATE:	04/15/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Tony Resendiz		TIME VISIT/ INSPECTION COMPLETED:	04:07 PM

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Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Clinical Director (CD) Tony Resendiz and discussed the purpose of the visit. The facility currently has four clients in care.

The facility is a one story home with a living room, 3 bedrooms, 3 bathrooms, kitchen, dining room, medication room, staff office, in ground swimming pool and an attached two car garage. The facility appears clean, safe, and sanitary. All resident bedrooms had the required components and furnishings. Facility has extra clean linens for client use located in the hall closet. Restrooms are stocked with soap and toilet paper. Hot water in the bathroom measured at 120.3 degrees Fahrenheit. LPA observed the kitchen to be clean and free of vermin. LPA observed the sharps to be locked in a drawer located in the kitchen and inaccessible to clients in care. LPA found that all appliances were operational. LPA observed that there were two fire extinguishers both charged and had a service date of December 15, 2025. LPA observed the centrally stored medications was locked in a closet located in the locked medication room and is inaccessible to clients in care. LPA observed the toxins and chemicals to be locked in a closet in the staff office and the locked garage making them inaccessible to clients in care. LPA observed the facility has an emergency food and water supply in the medication room. LPA observed activities supplies in the living room for client enjoyment. LPA observed the backyard to have shaded seating for client use. LPA observed the swimming pool to be fully enclosed. The swimming pool is surrounded on two sides by an 8ft brick wall with the other 2 sides surrounded by a 5ft wrought iron fence and locked. The backyard was free of obstructions. Carbon monoxide and smoke detectors were tested and found to be operational.

Continue on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: Hanna Gough
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: AMHS TELECARE TREEHOUSE CRISIS RESIDENTIAL NORTH	FACILITY NUMBER: 306005412
	VISIT DATE: 04/15/2026

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LPA reviewed staff files and 1 of 3 staff do not have a current CPR/first aid certification. LPA reviewed resident files and 2 of 4 residents do not have a medical assessment on file. The last fire drill was conducted on January 21, 2026 and observed staff do a fire drill during the inspection when CD set off the fire alarms. The facility does not safeguard client P&I. LPA reviewed client medications and no discrepancies were observed. All staff present are background cleared and associated to the facility.

LPA provided Legionnaires’ Disease fact sheet at the time of the inspection.

Based on todays observations a technical violation and deficiencies are being noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with LIC858, 859 and appeal rights were left at the facility.

NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: Hanna Gough
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/15/2026 04:05 PM - It Cannot Be Edited

Created By: Hanna Gough On 04/15/2026 at 03:50 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: AMHS TELECARE TREEHOUSE CRISIS RESIDENTIAL NORTH	FACILITY NUMBER: 306005412
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

81069(a)

Client Medical Assessments

(a) Prior to admitting a client into care or within 72 hours of admission, the licensee shall obtain and keep on file documentation of the client's medical assessment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 of 4 clients not having a medical assessment on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/01/2026
	Plan of Correction
1 2 3 4	Licensee stated they will obtain the medical assessments and send proof to LPA by POC due date.

Type B

Section Cited

CCR

81075(f)

Health-Related Services

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 of 3 staff not having a current first aid certificate which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/01/2026
	Plan of Correction
1 2 3 4	Licensee stated they will get the staff trained and send proof of certification to LPA by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM MANAGER:

	Hanna Gough
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

LIC809 (FAS) - (06/04)

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