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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006458
Report Date: 03/25/2024
Date Signed: 03/25/2024 10:15:07 AM

Document Has Been Signed on 03/25/2024 10:15 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, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:ADULT ENRICHMENT CENTERFACILITY NUMBER:
306006458
ADMINISTRATOR:KELSEY, WILLIAMFACILITY TYPE:
775
ADDRESS:1813 E DYER RD. #411TELEPHONE:
(714) 576-2688
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 121CENSUS: 121DATE:
03/25/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Pedro Perez, Applicant
Reese Perez, Applicant		TIME COMPLETED:
10:05 AM
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Component II completion: Successful

Facility Type: Adult Day Program
Application Type: Initial
Capacity: 121
Census (if any clients in care): 150-156, only 121 present per day.
COMP II Participants: Pedro Perez, Applicant
Reese Perez, Applicant
Interview Method: Virtual interview (Microsoft Teams)

On March 25, 2024, Applicant(s) and Administrator participated in COMP II for the below pending facilities:
  • Facility #1 Adult Enrichment Center—306006457
  • Facility #2 Adult Enrichment Center – Anaheim –306006458

Identification of the Applicants was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicants confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22.

During COMP II, CAB analyst confirmed Applicant’s understanding of following areas:
1. Facility Operation: License type, client/resident populations, and program.
2. Admission Policies
3. Staffing Requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General Provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing Readiness

Exit interview conducted with Applicants. Report sent via email and informed to return sign copy to CAB by end of business day today.
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Celia Phomphachanh
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2024
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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