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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006192
Report Date:
11/13/2024
Date Signed:
11/13/2024 02:30:38 PM
Document Has Been Signed on
11/13/2024 02:30 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:
VIOLA HOMES ESTATE
FACILITY NUMBER:
306006192
ADMINISTRATOR/
DIRECTOR:
SNETTER, MIATTA
FACILITY TYPE:
735
ADDRESS:
15770 AZALEA WAY
TELEPHONE:
(323) 304-4620
CITY:
WESTMINSTER
STATE:
CA
ZIP CODE:
92683
CAPACITY:
4
CENSUS:
3
DATE:
11/13/2024
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:
Gazel Montes
TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on an eviction notice submitted 10/30/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit.
Eviction notice dated 10/30/2024 indicated Client 1 (C1) was being evicted from the facility for aggressive behaviors. C1 has been at College Hospital since 08/09/2024 with no improvement in behaviors. Regional Center pulled the bed hold for the client effective 09/30/2024. LPA reviewed client file and email messages between Licensee and Regional Center regarding the situation. The client will not be returning to the facility upon discharge from College Hospital.
Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME
:
Alisa Ortiz
LICENSING EVALUATOR NAME
:
Kimberly Lyman
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/13/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/13/2024
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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