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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006230
Report Date: 10/28/2022
Date Signed: 10/28/2022 09:01:39 AM

Document Has Been Signed on 10/28/2022 09:01 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:TNL RESIDENTIAL CAREFACILITY NUMBER:
306006230
ADMINISTRATOR:LUU, THIENFACILITY TYPE:
735
ADDRESS:1665 S. IVANHOE ST.TELEPHONE:
(714) 797-6057
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 4CENSUS: 0DATE:
10/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Thien LuuTIME COMPLETED:
09:15 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an announced pre-licensing visit. This is the second pre-licensing visit. LPA met with applicant Thien Luu. LPA verified that the following three items have been corrected; small holes in all of the bedroom walls have been repaired and painted, all 4 client beds now have a top flat sheets and mattress pads and the infection control plan detailing how each mitigation regulation will be met completed. LPA reviewed the completed infection control plan and it has been approved. LPA and applicant toured the facility. LPA observed all 4 client beds had the proper bed linens including, top flat sheets, bottom fitted sheets, mattress pads, pillow and pillow cases and comforters and blankets. LPA observed all small holes in the bedroom walls have been repaired and painted. Facility meets Title 22 regulations. Facility is ready to be licensed.

Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. During the visit LPA explained the process of this application and also about the post licensing visit once the facility is licensed. Applicant was informed today that the final approval will be processed by the CAB unit in Sacramento.
An exit interview was conducted and a copy of this report, LIC809 was explained and provided to the applicant.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2022
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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