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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005918
Report Date: 08/19/2023
Date Signed: 08/19/2023 01:47:18 PM

Document Has Been Signed on 08/19/2023 01:47 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:LI'L HOUSE ON FARRINGTON, THEFACILITY NUMBER:
306005918
ADMINISTRATOR:JABONERO, JEREMIASFACILITY TYPE:
735
ADDRESS:1241 FARRINGTON DR.TELEPHONE:
(714) 975-3025
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 4CENSUS: 4DATE:
08/19/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Ricky Exconde, Direct Service Professional (DSP), James Quijano, and Jeremias Jabonero, AdministratorTIME COMPLETED:
01:48 PM
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On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced case management visit to the facility in conjunction with complaint control #: 22-AS-20230818143507

LPA Quiroz met with facility Administrator (AD) Jeremias Jabonero and explained reason for the visit.

While LPA Quiroz conducted inspection tour of exterior of facility premises along with (DSP) Ricky Exconde, LPA Quiroz observed no shaded area in facility for clients in care, staff and visitors. This was verified with (AD) Jabonero.

The following Technical Violation (LIC 9102-AN) was issued during today's date: 85087.2(b): Outdoor Activity Space

An exit interview was conducted with (AD) Jeremias Jabonero and a copy of this report and LIC 9102-AN
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2023
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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