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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370454
Report Date: 07/12/2024
Date Signed: 07/12/2024 03:33:19 PM

Document Has Been Signed on 07/12/2024 03:33 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:CLUB JFACILITY NUMBER:
304370454
ADMINISTRATOR/
DIRECTOR:		MARTIN, AUDRAFACILITY TYPE:
840
ADDRESS:1 FEDERATION WAY, SUITE #200TELEPHONE:
(949) 435-3400
CITY:IRVINESTATE: CAZIP CODE:
92603
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: DATE:
07/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Director, Hilaria DuronTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On 07/12/24 at 2:20PM, Licensing Program Analyst (LPA), Christine Jung conducted an unannounced case management inspection. Upon arrival, LPA met with Director, Hilaria Duran and was led on a tour of the facility. There were zero (0) children in care at the time of the inspection.

Due to time constraint, LPA will return at a later date to conduct an inspection.

No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Hilaria Duran.

(End of Report)
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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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