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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002916
Report Date: 03/14/2024
Date Signed: 03/14/2024 09:45:57 AM

Document Has Been Signed on 03/14/2024 09:45 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:ARC FACILITY AT CAMINO 2FACILITY NUMBER:
306002916
ADMINISTRATOR:MICHAEL ADAMSFACILITY TYPE:
740
ADDRESS:2209 CAMINO DEL SOLTELEPHONE:
(714) 870-5830
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 6CENSUS: 6DATE:
03/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Michael Adams-AdministratorTIME COMPLETED:
09:59 AM
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On this day Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an unannounced Plan of Correction (POC) visit in conjunction with complaint control #22-AS-20240116114800 and citation issued on 01/25/2024. LPA was greeted and granted entry into the facility by Administrator (AD) Michael Adams and explained the reason for the visit.

On 01/26/2024, AD failed to correct the following:
Deficiency cited under Title 22 Regulation 87208 (a)(12) pertaining to Plan of Operation (The Infection Control Plan).

As of 03/14/2024, Deficiency cited under Title 22 Regulation 87208 (a)(12) pertaining to Plan of Operation (The Infection Control Plan) has been CLEARED.

Licensee has read regulation and sign a statement of understanding. Licensee has complied with the terms of the POC.

LPA Ramirez conducted an exit interview with AD Adams and a copy of this report and Letter of Cleared Deficiency has been provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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