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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006126
Report Date: 02/03/2023
Date Signed: 02/03/2023 12:13:30 PM


Document Has Been Signed on 02/03/2023 12:13 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
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:RDB GUEST HOMEFACILITY NUMBER:
306006126
ADMINISTRATOR:BANGGALAT, REGIE DANCELFACILITY TYPE:
740
ADDRESS:2351 W. BROADWAYTELEPHONE:
(714) 519-5268
CITY:ANANHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 4DATE:
02/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Vanessa Batara, House ManagerTIME COMPLETED:
11:00 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted a case management visit for the purpose of delivering findings into the complaint investigation # 22-AS-20211103112454 received by the Department on November 3, 2021.

The initial facility #306004772 located at 612 Bronwyn Drive was closed for change of location on May 2, 2022, however the current facility is still operated by the same licensee. Findings were delivered and a complaint inspection report was generated under the initial closed facility.

An exit interview was conducted and a copy of this report was reviewed and left with facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2023
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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