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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003527
Report Date: 10/31/2024
Date Signed: 10/31/2024 11:37:26 AM

Document Has Been Signed on 10/31/2024 11:37 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:YORBA LINDA SENIOR CAREFACILITY NUMBER:
306003527
ADMINISTRATOR/
DIRECTOR:		CHRISTOPHER CURTISFACILITY TYPE:
740
ADDRESS:4451 ACORN COURTTELEPHONE:
(714) 993-0449
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 6CENSUS: 4DATE:
10/31/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:01 AM
MET WITH:Caregiver- Noel OrielTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On October 31, 2024, at 11:01am Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management POC visit in conjunction with the annual continuation visit on October 31, 2024 visit. LPA was met and greeted by Caregiver (CG) Noel Oriel and explained the purpose for the visit.

LPA verified that S1 and S2 have all their necessary and complete paperwork in their files. The deficiency (See LIC 809D dated 9/16/24) has been cleared. Facility representative provided with the POC letter documenting the correction.

An exit interview was conducted and a copy of this report was provided to Caregiver Noel Oriel.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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