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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006540
Report Date: 12/05/2024
Date Signed: 12/05/2024 02:51:20 PM

Document Has Been Signed on 12/05/2024 02:51 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 RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ARCHER RESIDENTIAL CAREFACILITY NUMBER:
306006540
ADMINISTRATOR/
DIRECTOR:		FADDOUL, LACYFACILITY TYPE:
740
ADDRESS:421 S ARCHER STTELEPHONE:
(661) 810-7293
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 5DATE:
12/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:03 PM
MET WITH:Miriam Esquivel, ManagerTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced case management visit and was greeted and granted entry into the facility by the Manager. The purpose of the visit was to deliver an amended report from December 5, 2024. LPA met with Miriam Esquivel, Manager at 2:03 PM and spoke with the Licensee, Lacy Faddoul, via phone.

An exit interview with a copy of this report, and the amended LIC 809, were provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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