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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006073
Report Date: 10/17/2022
Date Signed: 10/17/2022 11:53:29 AM

Document Has Been Signed on 10/17/2022 11:53 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:EDEN BY ENHANCEFACILITY NUMBER:
306006073
ADMINISTRATOR:KHOUIE, CHRISTINAFACILITY TYPE:
772
ADDRESS:35 MANN STREETTELEPHONE:
(714) 475-7013
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY: 6CENSUS: 1DATE:
10/17/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Program Director - Paula KirboTIME COMPLETED:
12:20 PM
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Licensing Program Analysts (LPAs) Celine De Perio and Kimberly Lyman conducted an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 09/21/2022. LPA De Perio and Lyman explained reason for visit and was met with Program Director (PD) Paula Kirbo.

For today's visit, LPA De Perio and Lyman verified that there is only 1 client in care.

Based on observation, and interviews conducted on 9/21/22, LPA De Perio observed that facility did not list facility number on website and staff were unaware that a facility number needed to be posted. This poses a potential threat on safety of clients in care.



*Deficiency cited under Title 22 Regulation 81011(a) pertaining to Advertisements and License Number. Licensees shall reveal each facility licence number in all advertisements in accordance with Health and Safety Code section 1514 has been CLEARED.

LPA De Perio and Lyman conducted an exit interview with PD Kirbo and a copy of this report was provided to the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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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