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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006179
Report Date: 11/15/2024
Date Signed: 11/15/2024 08:28:16 AM

Document Has Been Signed on 11/15/2024 08:28 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:FOOTHILL RESIDENTIAL CAREFACILITY NUMBER:
306006179
ADMINISTRATOR/
DIRECTOR:		QUEZADA, JOSHUAFACILITY TYPE:
735
ADDRESS:8404 E FOOTHILL STTELEPHONE:
(562) 756-6463
CITY:ANAHEIMSTATE: CAZIP CODE:
92808
CAPACITY: 4CENSUS: 3DATE:
11/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Joshua Quezada TIME VISIT/
INSPECTION COMPLETED:
09:22 AM
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Licensing Program Analyst (LPA) Samer Haddadin made an unannounced visit for the purpose of conducting a case management visit to verify recent floor plan update and fire clearance. Upon arrival, LPA met with Joshua Quezada who is the active Administrator (AD) and was granted entry into the facility.

During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:

This is a one-story home with four client bedrooms, two bathrooms, and attached two-car garage. The fourth Bedroom was recently constructed as an addition to the facility. All required documentation was submitted to the CCL regional office on September 4, 2024; a fire clearance was granted by the Anaheim Fire Department on November7th,2024. LPA inspected the fourth recently added room and observed that it had all required furniture: bed, clean linens, nightstand, TV, chair, closet, and ceiling lights. LPA also tested smoke detectors and carbon monoxide detectors which all tested operational. Fire extinguisher was observed to be fully charged with service tag dated April 22,2024.

Based on the observations made during today’s inspection for floor plan and fire clearance, no deficiencies found per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was given to the administrator.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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