<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006149
Report Date: 10/04/2022
Date Signed: 10/04/2022 10:33:19 AM


Document Has Been Signed on 10/04/2022 10:33 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:CARE CONNECTIONFACILITY NUMBER:
306006149
ADMINISTRATOR:GILBERT, ERICFACILITY TYPE:
740
ADDRESS:416 S JENNIFER LANETELEPHONE:
(714) 289-2273
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:6CENSUS: 4DATE:
10/04/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Eric Gilbert TIME COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Jerome Haley and Rosie Quiroz made an announced visit for the purpose of a pre-licensing evaluation. LPAs arrived at facility and were greeted and granted entry by applicant Eric Gilbert. LPAs were taken around the back of the facility to enter through the visitors entrance. Upon entry, LPAs were signed in and LPA Haley observed a COVID screening station near the door.

LPAs toured the facility with the applicant and LPAs observed that the following items have been corrected:

  • Water leak on the side of the house has been fixed and there's no signs of any pooled or puddled up water.
  • Disposable items on the side of the house has been removed.
  • Auditory exit alarms have have been installed in the bedrooms.
  • A bed has been placed in bedroom #6
  • 20x26 PUB475 See Something Say Something poster framed at the entrance of the facility.

LPAs did not observe any new deficiencies. Component III Power Point presentation with the applicant was successful. At this time the facility will be recommended for licensure.

An exit interview was conducted and a copy of this report was provided to Applicant Eric Gilbert.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022
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 1