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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006525
Report Date: 08/29/2024
Date Signed: 08/29/2024 12:00:21 PM


Document Has Been Signed on 08/29/2024 12:00 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:ABK ANGELS HOMECARE, INC.FACILITY NUMBER:
306006525
ADMINISTRATOR:TRUONG, BRENDA K.AFACILITY TYPE:
740
ADDRESS:10122 NORTHAMPTON AVETELEPHONE:
(714) 837-1823
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:6CENSUS: 6DATE:
08/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Brenda Truong-AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to get an amended annual inspection report signed. LPA conducted the annual inspection at the correct facility, but entered the report on the wrong facility 306006525 on 8/21/2024.

An exit interview was conducted where this report was discussed and a copy of the report was provided to Brenda Truong at the conclusion of the visit with appeal rights.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024
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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