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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006043
Report Date: 11/17/2022
Date Signed: 11/17/2022 12:54:44 PM

Document Has Been Signed on 11/17/2022 12:54 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:C-P RESIDENTIAL HOMESFACILITY NUMBER:
306006043
ADMINISTRATOR:PEREZ, CELIAFACILITY TYPE:
735
ADDRESS:894 SOUTH BARNETT ST.TELEPHONE:
(714) 519-4239
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 4CENSUS: 0DATE:
11/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Celia PerezTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted by Administrator (AD) Celia Perez and was granted entry into the facility. LPA Gutierrez discussed the purpose of the inspection. During the inspection LPA Gutierrez and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:

This is a one-story house with four bedrooms and two bathrooms. The facility currently has no clients in care. Per AD the house has not had a client since becoming licensed by Community Care Licensing (CCL). LPA Gutierrez verified that there were no clients in care. AD stated they wish to maintain the license at this time and will notify CCL when they admit a client into the facility, a physical inspection will also be completed at that time.

LPA reviewed and confirmed facility policies and practices regarding client screening, staff screening, visitation, COVID-19 testing, quarantine, isolation, cohorting, infection control training, PPE, and staffing.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 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: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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