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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006082
Report Date: 02/20/2025
Date Signed: 02/20/2025 04:43:53 PM

Document Has Been Signed on 02/20/2025 04:43 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:WAYMAKERS TRANSITIONAL AGE YOUTH CRISIS RES PRGRMFACILITY NUMBER:
306006082
ADMINISTRATOR/
DIRECTOR:		SAMAAN, LISAFACILITY TYPE:
772
ADDRESS:17332 AMAGANSET WAYTELEPHONE:
(949) 410-0467
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 6CENSUS: 4DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Lisa Samaan, Program Director TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct an annual visit. LPA was greeted and granted entry into the facility by Program Director Lisa Samaan and House Supervisor Lindsay Wilson explain the reason for the visit.

LPA Mendivil toured the facility with Program Director and House Supervisor. The facility is 3 bedrooms, 2 staff offices 3 bathroom,two story home with an attached garage. LPA Mendivil inspected the clients' bedrooms. LPA Mendivil observed that the bedrooms were clean, lights were operational, and furniture were in good conditions. LPA Mendivil observed that the bathrooms; toilets and sinks were clean.

LPA Mendivil inspected the kitchen. LPA Mendivil observed that the facility had a two-day supply of perishable food and a supply of seven-day of non-perishable foods as required. LPA Mendivil observed testing the facility smoke detectors and carbon monoxide detectors the detectors were operational. LPA Mendivil observed the poster PUB 475 Let Us No in hallway, visible to the public. LPA Mendivil observed that toxic chemicals were kept in locked staff room in a locked cabinet. LPA Mendivil observed that emergency food and water. LPA Mendivil observed secured and locked medication cabinet. LPA Mendivil observed that the clients medications were labeled. LPA Mendivil reviewed clients records and files.

Therefore, and based on the observations made during this annual inspection conducted per Title 22 of the California Code of Regulations, no citations were issued. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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