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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005931
Report Date: 06/04/2024
Date Signed: 06/04/2024 03:31:18 PM

Document Has Been Signed on 06/04/2024 03:31 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VA & C HOMES / TERANIMARFACILITY NUMBER:
306005931
ADMINISTRATOR/
DIRECTOR:
AU, ANTHONYFACILITY TYPE:
735
ADDRESS:3034 W. TERANIMAR DRTELEPHONE:
(714) 952-9641
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 6DATE:
06/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Augustine AuTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michael Tea made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for deficiencies issued on 04/15/2024 during the required annual inspection. LPA was greeted and granted entry by care giver Lan Nguyen. LPA discussed the purpose of the inspection with Assistant Administrator (AAD) Augustine Au, who arrived shortly after.

LPA Tea toured the facility to check deficiencies have been corrected with care giver Teotima Apostol. The toilet has been replaced with a brand new toilet, clearing the Type B deficiency CCR 80088(e)(3). LPA then went upstairs to the second floor of the facility and was shown the new evacuation chairs that were purchased recently. The purchase of the evacuation chairs clears the Type B deficiency HSC 1565(f)(1) issued from the annual inspection. LPA was shown records and certificates of staff training completed from online courses. Thus, clearing the Type B deficiency CCR 80022(e)(4), where documentation of staff training was met.

The Plan of Corrections has been fulfilled by the assigned POC due date of 04/29/2024 and the deficiencies have all been cleared.

An exit interview was conducted with Assistant Administrator Augustine Au and a copy of this report was provided via email.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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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