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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006294
Report Date: 04/30/2024
Date Signed: 04/30/2024 03:22:12 PM

Document Has Been Signed on 04/30/2024 03:22 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:TELECARE STEPHANIE HOUSEFACILITY NUMBER:
306006294
ADMINISTRATOR/
DIRECTOR:		WOOTEN-NEWMAN, KRISTENFACILITY TYPE:
737
ADDRESS:11702 STEPHANIE LANETELEPHONE:
(657) 667-6382
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 4CENSUS: 0DATE:
04/30/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Kristen Wooten-NewmanTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Kristen Wooten-Newman, discussed the purpose of the inspection, and toured the facility. Facility is to operate an Enhanced Behavioral Supports Home – Adult Residential Facility. Application was submitted to Community Care Licensing on December 21, 2022. This is an initial application with no persons in care.
During the inspection, LPA and AP observed the following: Structure: facility is a 4-bedroom, 2-bathroom, 1-story house with an attached garage that is being used for storage and office space. Facility telephone number is (657) 667-6382. Client Bedrooms: the 4 client bedrooms are spacious and will easily accommodate the clients’ furnishings. Lamps, chairs, linens, and storage for each client bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms: were clean, faucets and toilets were operational. Water temperature: tested between 110 and 112 degrees F in the two bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed 7 days nonperishable food supply and AP stated they will obtain 2 days’ perishable food supply prior to admitting their first client. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: will be locked in the kitchen. Toxins: will be locked in the kitchen and garage. Medication cart is locked. First-Aid Kit & Activity Supplies: observed and available. Client & Staff Files: this is an initial inspection. LPA inspected storage space for client and staff files. Fire clearance was approved by Orange County Fire Authority on November 22, 2023. Backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for clients. Component III was completed with AP during today’s inspection. AP will obtain liability insurance once application is approved.
During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AP.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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