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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005943
Report Date: 08/10/2022
Date Signed: 08/10/2022 01:16:01 PM


Document Has Been Signed on 08/10/2022 01:16 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:MANDEL HOUSEFACILITY NUMBER:
306005943
ADMINISTRATOR:YVETTE DORANFACILITY TYPE:
735
ADDRESS:2220 CONCORD STREETTELEPHONE:
(818) 782-2211
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:6CENSUS: 3DATE:
08/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Yvette DoranTIME COMPLETED:
01:15 PM
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Licensing Program Analyst Michelle Reed arrived at the facility to discuss several unusual incident reports that were sent to the Licensing Office. Upon arrival, LPA met with Staff Gabriel Negrete. Administrator Yvette Doran was contacted and she arrived a short time later.

The unusual incidents involved Client #1(C1). Client #1 was admitted to the facility on 3/1/22. He eloped from the facility on 7/30/22, 8/1/22, 8/2/22, 8/3/22. Client #1 had a history of elopement prior to admission. He was brought back by the police during the first incident on 7/30/22 and then by Administrator Yvette Doran during the August incidents.

On 8/3/22 the Orange County Crisis Intervention Team was contacted and C1 was transferred to OC Global Hospital. C1 has not returned to the facility.

At this time, no citations issued.

Ms. Doran understands that if C1 returns to the facility, an elopement plan must be put into place and the staffing levels should be sufficient to meet C1's needs.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2022
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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