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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006539
Report Date: 08/26/2024
Date Signed: 08/26/2024 08:42:26 AM

Document Has Been Signed on 08/26/2024 08:42 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CONNECTIONS MENTAL HEALTHFACILITY NUMBER:
306006539
ADMINISTRATOR/
DIRECTOR:		ALCALA, PABLOFACILITY TYPE:
772
ADDRESS:17841 LINCOLN STREETTELEPHONE:
(949) 742-0172
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY: 6CENSUS: DATE:
08/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Pablo AlcalaTIME VISIT/
INSPECTION COMPLETED:
09:05 AM
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Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing follow up inspection. LPA identified herself and discussed the purpose of the visit. An initial application to operate a Social Rehabilitation Facility was submitted to CCL on 03/22/2024 for a capacity of six ambulatory clients. Upon entry, facility appears clean, safe and sanitary.

At 8:25 AM, LPA toured the facility and observed the following:
  • Facility has an evacuation chair at top of stairwell.
  • Facility has removed debris from side of house.
  • Facility has cleaned patio table and added additional chairs for clients.






Facility is ready to be licensed.





Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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