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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005987
Report Date: 02/06/2025
Date Signed: 02/06/2025 12:26:48 PM

Document Has Been Signed on 02/06/2025 12:26 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:ATLANTA HOUSEFACILITY NUMBER:
306005987
ADMINISTRATOR/
DIRECTOR:		LOPEZ, ANICIAFACILITY TYPE:
735
ADDRESS:2204 S ATLANTA STTELEPHONE:
(714) 539-0696
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 5DATE:
02/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Mina BaltazarTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On February 6th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of an annual visit. Upon arrival LPA Vanegas was greeted and granted entry by Care Giver (CG) Mina Baltazar. LPA Vanegas explained the nature of the visit and began to set up equipment and began a tour of the facility and observed the following.

This a one storied home with four bedrooms one of which is a staff room. There are three bathrooms two of which are client bathrooms and one of which is a staff bathroom. There is also an attached two car garage. LPA Vanegas observed kitchen to be clean and free of debris. LPA Vanegas observed there to be a dishwasher, gas stove, microwave, refrigerator, and washer and dryer. All were tested and observed to be operational. LPA Vanegas observed there to be a two day supply of perishable food and a seven day supply of non-perishable food with a sufficient amount of emergency water.

LPA Vanegas observed client restrooms to be clean and free of debris with all required furnishings such as grab bars, slip resistant floor matts, and shower chair. Toilet and water faucet tested to be operational water tested between 104.5 and 105.1 degrees. LPA Vanegas observed client rooms to have all required furnishings such as a bed, chest drawers, a lamp, and clean linens in good repair meaning no strains or tears.

LPA Vanegas observed fire extinguisher to be fully charged and up to date. LPA Vanegas observed all smoke detectors and carbon monoxide detectors to be operational and in good repair. LPA Vanegas observed fire drill log to be up to date. LPA Vanegas observed first aid kit to have all required materials such as adhesive tape, tweezers, scissors, a thermometer, and a first aid manual.

CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ATLANTA HOUSE
FACILITY NUMBER: 306005987
VISIT DATE: 02/06/2025
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LPA Vanegas observed outside of facility to be clean and free of any obstructions along the exit routes side doors are not locked and are self latching. LPA Vanegas observed there to be an outdoor shaded sitting area, and the backyard to be big enough to participate in outdoor activities at client's request.

LPA Vanegas reviewed P&I with staff member and observed all balances to be up to date and accounted for. LPA Vanegas observed all sharps, toxins, and medications to be locked away and inaccessible to clients in care. LPA Vanegas reviewed medication administration log with staff and observed that all medications are being documented when administered and medications are being administered per physicians orders.

LPA Vanegas reviewed three staff files, and four client files. All files (Staff and Client) Have all the required documentation and all training is up to date and documented correctly. LPA Vanegas reviewed disaster preparedness plan and infection control plan to be filled out and up to date.

Based on observations made during today's visit no deficiencies will be cited per title 22 chapter six of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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