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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
304311174
Report Date:
11/25/2024
Date Signed:
12/18/2024 05:03:33 PM
Document Has Been Signed on
12/18/2024 05:03 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 CC RO
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
ZEPEDA, GLADYS
FACILITY NUMBER:
304311174
ADMINISTRATOR/
DIRECTOR:
ZEPEDA, GLADYS
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(714) 869-5094
CITY:
SANTA ANA
STATE:
CA
ZIP CODE:
92707
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
DATE:
11/25/2024
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:
TIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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SUPERVISORS NAME
:
Thuy Ho
LICENSING EVALUATOR NAME
:
Cynthia Sun
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/25/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/25/2024
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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