Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312418
Report Date: 10/26/2017
Date Signed 10/26/2017 09:41:13 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LEE, HEASOOKFACILITY NUMBER:
304312418
ADMINISTRATOR:LEE, HEASOOKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 768-6756
CITY:ANAHEIMSTATE: CAZIP CODE:
92808
CAPACITY:14CENSUS: 9DATE:
10/26/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Heasook Lee-LicenseeTIME COMPLETED:
09:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
The purpose of this inspection was to conduct a Case Management Evaluation of the facility. LPA Taylor toured the home inside and outside and a census was taken. Observed was 9 children in care. Also present during inspection was licensee's mother, adult son and adult daughter. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

No deficiency cited during today's inspection.


An exit interview was completed. Appeal Rights and deficiencies were discussed. A copy of the Appeal Rights was given to the facility representative. All appeals must be in writing and received by the Licensing office within 15 days.

THE FACILITY REPRESENTATIVE WAS INFORMED THAT THE 'NOTICE OF SITE VISIT' MUST BE POSTED FOR 30 CONSECUTIVE DAYS. FAILURE TO POST WILL RESULT IN CIVIL PENALTIES OF $100.00. THE 'NOTICE OF SITE VISIT' WAS POSTED ON THE DOOR.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1