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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005552
Report Date: 09/03/2021
Date Signed: 09/03/2021 12:35:17 PM

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:KAEGO'S RICHMAN GARDENS BY SERENITY CARE HEALTHFACILITY NUMBER:
306005552
ADMINISTRATOR:OGBECHIE, BIOSEHFACILITY TYPE:
740
ADDRESS:317 N RICHMAN AVETELEPHONE:
(714) 213-8248
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:26CENSUS: 10DATE:
09/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Joana CortesTIME COMPLETED:
12:45 PM
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of a case management inspection to return files taken from the facility by LPA on 9/1/21 for the purpose of making copies. LPA met with Staff member (S1) Joana Cortes and discussed the purpose of the inspection. Administrator (AD) Ray Kuzara was not present during the inspection.

During today’s inspection, LPA provided the files previously taken to S1 and concluded the inspection.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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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