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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005987
Report Date: 03/04/2025
Date Signed: 03/24/2025 03:46:40 PM

Document Has Been Signed on 03/24/2025 03:46 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:
03/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Martin LopezTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection due to a special incident report (SIR) received on February 6,2025. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Direct Support Staff (DSP) Mina Baltazar. LPA Vanegas met with Licensee/Administrator (AD) Martin Lopez and explained the purpose for the inspection.

During the course of the investigation LPA Vanegas conducted a tour of the facility, conducted health and safety checks of clients, reviewed resident roster, staff roster, staff files, and resident files.

Interviews were conducted with facility staff, AD, and alleged victim, who all corroborated the alleged personal rights violation of Staff 1 (S1) slapping Resident 1 (R1) on the face. LPA Vanegas attempted to interview alleged perpetrator. However, LPA Vanegas was unable to make contact.

LPA Vanegas obtained copies of termination letter, S1’s last day of employment with this facility was on February 21,2025. Based on interviews conducted and records observed, a citation will be cited per tittle 22-chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with AD Martin Lopez, and a copy of this report was left at the facility.

NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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: 03/04/2025
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Interview with AD Martin Lopez revealed the following: Per AD Lopez they were not here at the time of the incident, however AD Lopez conducted an interview with alleged perpetrator and stated that through out the interview alleged perpetrator admitted several times to slapping alleged victim. AD rephrased the question several times in order to make sure alleged perpetrator was understanding the question to it's full extent. Alleged perpetrator's preferred language is Vietnamese. AD Lopez was asked if a translator was provided, and stated that one was not provided. AD Lopez stated that after an internal investigation was completed alleged perpetrator was separated from the company and was escorted off the facility. AD Lopez provided LPA Vanegas with a termination letter, and and employee separation agreement and release stating that alleged perpetrator is no longer employed with the company.

Interview with alleged victim revealed the following: Client is non-verbal, however alleged victim is able to gesture. When asked to describe what happened with alleged perpetrator, alleged victim made a slapping gesture to their face. When asked if there was anything else alleged victim would like to add anything to our conversation alleged victim stated no, and continued to repeat the slapping gesture to their face.

After concluding the interviews, and completing record reviews. The allegations are deemed to be substantiated and further action will be discussed with management, and relayed to facility. An exit interview was conducted and a copy of this report was left at the facility.
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
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