306006539-9-9-2025-22-AS-SHAN-DLCP6J-20250909110225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006539
Report Date: 09/08/2025
Date Signed: 09/09/2025 11:03:37 AM

Document Has Been Signed on 09/09/2025 11:03 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:	CONNECTIONS MENTAL HEALTH		FACILITY NUMBER:	306006539
ADMINISTRATOR/ DIRECTOR:	ALCALA, PABLO		FACILITY TYPE:	772
ADDRESS:	17841 LINCOLN STREET		TELEPHONE:	(949) 742-0172
CITY:	VILLA PARK	STATE: CA	ZIP CODE:	92861
CAPACITY: 6		CENSUS: 6	DATE:	09/08/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:09 AM
MET WITH:	Dave Grasso		TIME VISIT/ INSPECTION COMPLETED:	02:28 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the above facility to complete the required annual inspection. Upon arrival, LPA met with Operational Manager (OM) Dave Grasso and Pablo Alcala ,who is an Administrator, and explained the purpose of the visit. The facility operates as a Social Rehabilitation Facility. The facility is a two-story home with five bedrooms, three bathrooms, and an attached garage. The first floor contains one bedroom utilized as a therapy room and one restroom. The second floor consists of four bedrooms and two restrooms. During the inspection, LPA toured both the interior and exterior portions of the facility with OM and observed the following. All bathrooms were clean and operational. Hot water was tested and measured between 137.4- and 136.9-degrees Fahrenheit. The kitchen was clean and organized with an adequate supply of food, including at least a two-day supply of perishable items and a seven-day supply of non-perishable goods. Knives and cleaning supplies were secured in a locked exterior cabinet and inaccessible to clients. Fire extinguishers were observed to be fully charged, with the most recent service date recorded as January 28, 2025. All kitchen appliances were in working condition. Client bedrooms were inspected and contained the required furnishings. The living room was furnished with a couch, chairs, and a television for client use. The backyard included a covered patio with a seating area. No bodies of water were present. The exit gate was operational, and no obstacles or hazards were observed. Smoke and carbon monoxide detectors were tested and found to be operational. The first aid kit contained all required elements. Facility records showed that the most recent fire drill was conducted on August 25, 2025. {*CONTINUE 809C*}

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Samer Haddadin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CONNECTIONS MENTAL HEALTH	FACILITY NUMBER: 306006539
	VISIT DATE: 09/08/2025

NARRATIVE

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A review of clients’ files revealed no discrepancies. Staff files were also complete, each containing the required documentation.
Based on observations made during this inspection, ONE deficiency is being cited in accordance with Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report, along with appeal rights, was provided to the OM at the conclusion of the inspection.

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Samer Haddadin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/09/2025 11:03 AM - It Cannot Be Edited

Created By: Samer Haddadin On 09/09/2025 at 10:51 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CONNECTIONS MENTAL HEALTH	FACILITY NUMBER: 306006539
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

81088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in having hot water tempertature in restoom at 137.4-136 degree F, which poses an immediate health, safety to persons in care.
	POC Due Date: 09/10/2025
	Plan of Correction
1 2 3 4	Admin lowered the temperature and now is reading 110 dgree F

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:

	Samer Haddadin
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

LIC809 (FAS) - (06/04)

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