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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006074
Report Date: 06/22/2023
Date Signed: 06/23/2023 06:55:00 AM

Document Has Been Signed on 06/23/2023 06:55 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:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Frances SnoddyTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Lydia Martinez made an announced visit to the facility to conduct a Required - 1 Year inspection. LPA was greeted and granted entry by staff Mark Sims and reason for visit was stated. Administrator (AD) Frances Snoddy arrived shortly after. AD Snoddy's Administrator's Certificate expired on 01/13/2023. AD stated she has submitted all documents required to renew. Certificate is pending. Two staff and four clients were present during today's visit.

LPA, conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following: Facility is a one story house with 4 bedrooms, 3 bathrooms, Office, Living Room, Dining Room, Kitchen and an attached 2 car garage that is used for storage only. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Backyard has a covered patio with table and chairs for clients and visitors enjoyment. Client bedrooms were observed to be spacious and easily accommodate furnishings such as lamps, chair, dresser and a bed. Facility does not have live-in staff. Bathrooms were clean, faucets, showers and toilets were operational. Hot water temperature in client bathrooms was within regulatory requirements. Linen and hygiene supplies were ample for clients in care. Emergency Phone Numbers and Exit Plan were reviewed. Food prep area is clean and organized. Food supply was noted to be in sufficient quantities to meet the regulatory requirements of a 2-day perishables and 7-day non-perishables. Emergency food and water supply is available. Smoke detectors and carbon monoxide detectors were found to be operational. Fire Extinguisher was mounted, last charged on 03/22/2022. Fire drills are conducted quarterly and LPA verified last Fire Drill was conducted on 05/03/2023. Stove burners, microwave, dishwasher, washer, and dryer are operational. Chemicals and sharps are made inaccessible to the clients. Medications are centrally stored in a locked cabinet in the office. Medications reviewed appear to be dispensed accurately.



(continued on LIC809C)
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 #5
FACILITY NUMBER: 306006074
VISIT DATE: 06/22/2023
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First-Aid Kit had all the required elements and Activity Supplies were observed and available. There is a working land line (714) 829-4505 at the facility. The LIC610D, Emergency Disaster Plan is posted.

LPA reviewed four client files and two staff file. The clients P&I records were reviewed.

Based on observations made, no deficiencies were observed at this time in the areas evaluated. An exit interview was conducted with AD and a copy of this report will be sent to email on file.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
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