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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005817
Report Date: 06/07/2022
Date Signed: 06/07/2022 01:49:32 PM

Document Has Been Signed on 06/07/2022 01:49 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:DALLAS HOMES, INC.FACILITY NUMBER:
306005817
ADMINISTRATOR:MAGLALANG, LOUELAFACILITY TYPE:
735
ADDRESS:1900 W. VICTORIA AVENUETELEPHONE:
(714) 932-9466
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 3DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Mark Ryan CentenoTIME COMPLETED:
02:10 PM
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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 and staff toured the facility. Facility has 4 bedrooms, 1 office, kitchen, living room, 3 bathrooms and a 2 car garage that is used for storage and a laundry room that can only be accessed from the outside. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable, 7 day non-perishable food supply on hand. The fire extinguisher in the kitchen was fully charged. Smoke detectors and carbon monoxide detector tested operational. Medication is kept locked in a closet along with sharp objects. LPA observed all 3 bathrooms were clean and operational. The office is kept locked and off limits to clients. All client rooms had the required furnishings and had enough space to accommodate the clients. LPA observed the fireplace in the living room is screened. LPA and staff toured the backyard. There is a covered patio with a seating area for clients. The exit gates are operational. No obstacles or hazards observed inside or outside of the facility. No deficiencies observed during the visit. No deficiencies are being cited. 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: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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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