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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006182
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:45:15 PM

Document Has Been Signed on 09/13/2023 03:45 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LUCHEN SANTOS HOMES INC.FACILITY NUMBER:
306006182
ADMINISTRATOR:SANTOS, MARGIE ROSE AFACILITY TYPE:
740
ADDRESS:6075 BELLE AVENUETELEPHONE:
(714) 858-0046
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 4CENSUS: 3DATE:
09/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Margie Rose SantosTIME COMPLETED:
04:00 PM
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This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 09/12/23 regarding an allegation of abuse made by Client #1 (C1). LPA met with Administrator (AD) Margie Rose Santos and discussed the purpose of the inspection.

During today’s inspection, LPA conducted a health and safety check on C1 and all other clients present and observed no health and safety issues. LPA interviewed AD, C1, C1’s family member, 2 additional clients, and 2 staff. LPA requested and reviewed C1’s Individual Service Plan, Individual Program Plan, Behavior Tally Sheets, and Body Check. The evidence obtained did not substantiate the allegation.

Based on the information obtained during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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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