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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005988
Report Date: 05/15/2024
Date Signed: 05/15/2024 10:42:00 AM

Document Has Been Signed on 05/15/2024 10:42 AM - 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ARCHER I HOUSEFACILITY NUMBER:
306005988
ADMINISTRATOR/
DIRECTOR:		LOPEZ, ANICIAFACILITY TYPE:
735
ADDRESS:520 S ARCHER STTELEPHONE:
(714) 776-8536
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 5DATE:
05/15/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Matilde Venture - House ManagerTIME VISIT/
INSPECTION COMPLETED:
09:35 AM
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LPA arrived at the facility for the purpose of conducting a plan of corrections visit. LPA arrived at the facility and was greeted and granted entry by Matilde Ventura, House Manager. LPA explained the nature of the visit.

LPA observed that all client rooms windows were repaired and cleaned, the broken gutter and unused bed in the backyard were removed, the broken latch on one of the side gates was repaired and the broken doors on the outdoor storage shed were repaired and observed to be locked. LPA observed the P&I funds are in the facility and accessible as well.

Based on observations, the facility completed their plan of corrections by the assigned POC due date.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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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