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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 04:42:48 PM

Document Has Been Signed on 02/20/2025 04:42 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:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:06 PM
MET WITH:Lisa Samman, Program Director TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a case management visit. LPA was greeted and granted entry into the facility and explained the reason the visit.

The Department received an Unusual Incident/ Injury Report for an incident on 2/12/2025. It was reported that Client 1 (C1) eloped from the facility around 7:55pm, staff followed after but was unable to keep eyes on C1. Tustin Police Department was notified and a missing persons report was filed.

Program Director stated they attempted to contact listed emergency contacts for C1 but were unable to reach them. Program Director stated also utilized Orange County Health Care Agency to see if C1 was in any county facility, but C1 was not located.

Per Physician's report for C1 dated 01/14/2024 it is stated that C1 is able to leave the facility unassisted. Program Director stated will still follow up with Orange County Health Care Agency Contract Monitor C1's whereabouts.
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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