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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005610
Report Date: 06/22/2022
Date Signed: 06/22/2022 11:34:33 AM

Document Has Been Signed on 06/22/2022 11:34 AM - 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:TCT HOMES / N. COOLIDGEFACILITY NUMBER:
306005610
ADMINISTRATOR:AU, ANTHONYFACILITY TYPE:
735
ADDRESS:328 N. COOLIDGE AVETELEPHONE:
(714) 952-1497
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: 4DATE:
06/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Augustine Au, Maxine KniazeffTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA met with Administrator Maxine Kniazeff. LPA and Administrator toured the facility. Facility is a single story house with an attached garage which can be used as a recreation area. Facility has 6 bedrooms and 2 bathrooms, kitchen, dining room and a great room. LPA observed the See Something Say Something poster (PUB 475) in the entry way of the facility. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station next to the facility entrance. The fireplace in the dining room is screened. The great room has two large couches, a sofa, TV and a table with chairs. Both bathrooms are clean and operational. Hot water measured 111.0 degrees Fahrenheit in both bathrooms. All client bedrooms had the required furnishings. Each client has their own room. LPA observed a two day perishable and a seven day non-perishable food supply on hand in the kitchen. LPA inspected the first aid kit. All fire extinguishers are fully charged. The smoke detectors tested operational. Medication is kept locked in a kitchen cabinet. LPA and Administrator toured the backyard. There are two storage sheds in the backyard. Both storage sheds are kept locked and used to store supplies. There is one exit gate on each side of the house, Each exit gate is latched and operational. The garage is used to store old furniture and has a refrigerator with extra food and water. The garage has a table and chairs and exercise equipment for the clients. No bodies of water observed in the backyard. No obstacles or hazards observed in the backyard. LPA observed 4 staff working during the visit. Administrator Augustine Au arrived after the tour was completed. Administrator Maxine Kniazeff left the facility right after Administrator Augustine Au arrived. LPA consulted with the Administrator concerning continued Covid-19 mitigation procedures and reporting requirements. 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: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2022
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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