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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006074
Report Date: 10/24/2022
Date Signed: 10/24/2022 11:55:31 AM

Document Has Been Signed on 10/24/2022 11:55 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:SUCCESSFUL PEOPLE LLC #5FACILITY NUMBER:
306006074
ADMINISTRATOR:SNODDY, FRANCESFACILITY TYPE:
735
ADDRESS:1774 W CHALET AVETELEPHONE:
(310) 902-4893
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 4CENSUS: 4DATE:
10/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Shaneric Allen, Facility House ManagerTIME COMPLETED:
11:56 AM
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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit to Successful People LLC#5. LPA Rosie Quiroz was COVID-19 screened and allowed entry into the facility by Facility House Manager. Administrator Frances Snoddy was notified about today's unannounced visit to the facility by Facility House Manager. The purpose of today's Case Management visit was to follow-up on an incident report dated 10/17/2022 received at Community Care Licensing Orange County Regional Office on 10/18/2022 regarding Client 1 (C1).

On today's visit, LPA Quiroz conducted interviews with interviewees. LPA Quiroz along with Facility House Manager conducted a tour of interior and exterior of facility premises. LPA Quiroz was provided with copies of pertinent documentation for (C1). During today's visit, LPA Quiroz reviewed Individual Program Plan dated 8/19/2022 and Physician Report dated 10/1/2022.

Based on today's interviews and documentation review, there are no deficiencies being cited during this Case Management visit. An exit interview was conducted with Administrator Frances Snoddy and a copy of this report along with the LIC 811-Confidential Names were provided at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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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