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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006555
Report Date:
09/27/2024
Date Signed:
09/27/2024 04:05:59 PM
Document Has Been Signed on
09/27/2024 04:05 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:
HORIZONS HOME
FACILITY NUMBER:
306006555
ADMINISTRATOR/
DIRECTOR:
WILSON, LELAND C
FACILITY TYPE:
735
ADDRESS:
613 W AMERIGE AVE
TELEPHONE:
(714) 504-3862
CITY:
FULLERTON
STATE:
CA
ZIP CODE:
92832
CAPACITY:
2
CENSUS:
0
DATE:
09/27/2024
TYPE OF VISIT:
Prelicensing
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:
Licensee,Leland Wilson
TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Jenifer Tirre made a announced inspection visit to follow up on corrections identified during Pre Licensing visit on 09/06/2024. LPA identified themselves and discussed the purpose of the visit with Licensee Leland Wilson. An initial application to operate a Adult Residential Facility was submitted to CCL on 05/09/2024. There are 0 clients in care during today's visit. LPA observed the following:
At 2:00 PM LPA toured facility with Licensee and observed the following:
Front porch railing is secured in place
Audible alarms are in place for exit doors and windows
Window in client 1 bedroom has been repaired
floor heater between living room and hallway is now secured
staff room has lock on door
backyard furniture is updated
Backyard common areas have been cleared of cobwebs
backyard aisle way floor is leveled near crawl space
Grape vines have been removed in backyard patio
backyard has been cleared of clutter
Office work room has been cleared of unused furniture
Facility has internet access Tablet
self latch on driveway gate
locks on small storage unit
Department postings have been placed near entry way
Component III was conducted during visit. Noted items from visit on 09/06/2024 have been addressed.
Facility is ready to be licensed.
Exit interview conducted with Licensee and a copy of this report was left at the facility.
SUPERVISORS NAME
:
Lourdes Montoya
LICENSING EVALUATOR NAME
:
Jenifer Tirre
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/27/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/27/2024
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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