<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004813
Report Date: 10/08/2021
Date Signed: 10/08/2021 04:58:30 PM

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:CRITTENTON SERVICES OF O.C. - AMERIGE HOUSEFACILITY NUMBER:
306004813
ADMINISTRATOR:LYNDA SCARLINOFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 2DATE:
10/08/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Erika VasquezTIME COMPLETED:
05:30 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
On October 08, 2021 at 8:30 AM, Licensing Program Analysts (LPA) Jesus Cervantes continued an annual inspection at the facility which was started on October 06, 2021. LPA met with Program Director, Erika Vasquez and Assistant Program Director, Michael Saavedra.

LPA discussed and reviewed the following inspection components; Operations, Disaster Preparedness, Emergency Intervention Plan, and Client with Special Needs.

There are two clients in care. All the client files are stored and locked in filing cabinets within the staff offices. At 11:00 AM, two of two client files were reviewed during the time of inspection. All client files had the required forms per regulations requirements. LPA attempted to interview two clients, however they declined to be interviewed.

All the staff files are stored and secured in the Human Resources office at the facility corporate office located at 801 E. Chapman Ave. #203 in Fullerton, CA 92831. Staff records are accessible electronically via a secured records portal. At 1:30 PM, LPA reviewed six of six staff files. All the staff have met the training and qualification requirements per regulations requirements. Per a review of the Community Care Licensing Information System (LIS), all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements.

Based on the facility inspection on this date, there are no deficiencies found at this time. A copy of this report was reviewed and provided to facility representative.

SUPERVISOR'S NAME: Ann ValenzuelaTELEPHONE: (951) 204-8846
LICENSING EVALUATOR NAME: Jesus CervantesTELEPHONE: (714) 292-5537
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1