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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005466
Report Date: 11/16/2022
Date Signed: 11/16/2022 01:57:28 PM

Document Has Been Signed on 11/16/2022 01:57 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MY DAY COUNTS - TRAINING ACTIVITY PROGRAMFACILITY NUMBER:
306005466
ADMINISTRATOR:BRITTAIN, KINSLEYFACILITY TYPE:
775
ADDRESS:227 W. CARL KARCHER WAYTELEPHONE:
(714) 744-5301
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 200CENSUS: 79DATE:
11/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Eric Cid-Lopez, Sara WhitebirchTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). Facility is an adult day program. LPA was greeted and granted entry by staff. LPA met with Compliance Officer (CO) Sara Whitebirch and Director of Operations (DO) Eric Cid-Lopez. LPA, DO and CO toured the facility. LPA observed all staff were wearing masks. LPA observed clients were involved in various activities throughout the facility including, guided exercise, reading and drawing. LPA observed the dining area was clean and tables were more than 10 feet apart and plastic dividers were on each table. At this time the facility is not offering any food service. LPA observed multiple open activity rooms with arts and crafts supplies. LPA observed all fire extinguishers were fully charged. LPA observed that the entry of the facility has a check in station. Facility has a infection control plan that has been approved. Visitors and staff are pre-screened for Covid-19 symptoms when they arrive. Hand sanitizer is available throughout the facility. There are numerous pre-cautionary signs for Covid-19 mitigation. Facility is clean and organized. LPA did not observe any obstacles or hazards inside or outside of the facility. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
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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