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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006415
Report Date: 06/18/2024
Date Signed: 06/18/2024 08:51:53 AM

Document Has Been Signed on 06/18/2024 08:51 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:J AND P HOMES/EUDORAFACILITY NUMBER:
306006415
ADMINISTRATOR/
DIRECTOR:		BARRIOS, PRESCILA S.FACILITY TYPE:
735
ADDRESS:10269 EUDORA AVENUETELEPHONE:
(714) 296-5135
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 1DATE:
06/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Melba Santos TIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) Jerome Haley made an announced visit to conduct the second pre-licensing inspection. LPA Haley was greeted and granted entry by staff. LPA Haley explained the reason for the visit upon entry. Administrator Melba Santos was present for the visit.

During a tour of the physical plant, LPA Haley observed that the following items have been corrected:

1) The unfinished portion of the ceiling in the garage has been completed, 2) The table that was on the side of the facility has been removed.



All items have been corrected and no additional corrections were observed.

The facility meets regulation requirements and is ready to be licensed.

Component III was presented to Administrator Melba Santos.

An exit interview was conducted, and a copy of this report was provided to Administrator Melba Santos.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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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