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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 11:43:24 AM

Document Has Been Signed on 10/17/2022 11:43 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:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Paula Kirbo TIME COMPLETED:
11:35 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Kimberly Lyman and Celine DePeiro conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20221010165215. LPAs were greeted and granted entry into the facility and explained the reason for the visit.



During the complaint visit, LPAs observed all smoke detectors have been removed from facility bedrooms and dining room (photos). There is not an active smoke detector in the facility.











Based on the observations made during today's visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the Program Director and a copy will be provided as well as appeal rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
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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Document Has Been Signed on 10/17/2022 11:43 AM - It Cannot Be Edited


Created By: Kimberly Lyman On 10/17/2022 at 11:22 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EDEN BY ENHANCE
FACILITY NUMBER: 306006073

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2022
Section Cited
CCR
87203

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All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not being met as evidenced by:
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Licensee to install smoke detectors and forward proof to LPA by POC due date.
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Based on observation, Licensee failed to ensure fire dafety is being maintained. All smoke detectors in client rooms and dining room have been removed (photos). This poses an immediate health and safety risk to clients in care. CIVIL PENALTY ASSESSED.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alisa Ortiz
LICENSING EVALUATOR NAME:Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2022


LIC809 (FAS) - (06/04)
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