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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006070
Report Date: 10/13/2021
Date Signed: 10/13/2021 11:26:27 AM

Document Has Been Signed on 10/13/2021 11:26 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:COASTAL CHARM OF TUSTINFACILITY NUMBER:
306006070
ADMINISTRATOR:ALI, AHMADFACILITY TYPE:
740
ADDRESS:13341 ETON PLACETELEPHONE:
(949) 357-7633
CITY:NORTH TUSTINSTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 0DATE:
10/13/2021
TYPE OF VISIT:POCANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ahmad AliTIME COMPLETED:
11:30 AM
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Licensing Program Analysts Michelle Reed and Beverly Thompson-Gracia arrived at the home to conduct a Plan of Correction visit. Upon arrival, LPAs met with Applicant Ahmad Ali. A tour of the physical plant was conducted. All corrections have been completed. The floors were cleaned, carpet was removed, washer and dryer were connected and operating and the water temperature was within regulation guidelines.

The Licensee will be granted upon a final review by the Central Applications Bureau and approval by management.

An exit interview was conducted and a copy of this report was provided to Mr. Ali.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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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