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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006505
Report Date: 11/15/2024
Date Signed: 11/19/2024 12:23:07 PM

Document Has Been Signed on 11/19/2024 12:23 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, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:MENTAL HEALTH HOUSE, LLCFACILITY NUMBER:
306006505
ADMINISTRATOR/
DIRECTOR:		DYAR, COLEFACILITY TYPE:
772
ADDRESS:10618 EL TORO AVENUETELEPHONE:
(559) 303-8854
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 6CENSUS: 0DATE:
11/15/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Licensee Paul Alexander & Administrator Cole DyarTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Component II completion: Successful

Facility Type: SRF
Application Type: 306006505/INITL, 306006508/CHOW, 306006509/CHOW
Capacity: 6 (each facility)
Census (if any clients in care): 306006505/0, 306006508/6, 306006509/6
COMP II Participants: Licensee Paul Alexander & Administrator Cole Dyar
Interview Method: Virtual interview (Teams)


On 11/15/2024, applicant & administrator participated in COMP II for the below pending facilities: Mental Health House LLC/306006505, Mental Health House LLC/306006508 and Mental Health House LLC/306006509. Identification of the applicant(s) and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant(s) and administrator 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. Signed LIC 809 with copy of photo ID have been obtained.

During COMP II, CAB analyst confirmed Applicant/Administrator’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
Pre-licensing readiness
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Biridiana Cisneros
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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