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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000289
Report Date: 08/26/2021
Date Signed: 08/26/2021 02:26:22 PM

Document Has Been Signed on 08/26/2021 02:26 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:LAGUNA PALMSFACILITY NUMBER:
306000289
ADMINISTRATOR:MICHAEL MILOFACILITY TYPE:
740
ADDRESS:24571 KINGS ROADTELEPHONE:
(949) 859-7929
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 5DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Julieta MiloTIME COMPLETED:
02:44 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by Administrator Julieta Milo. Michael Milo's Administrator's certificate expires 9/6/2021. LPA and Administrator toured the facility. Facility has 7 bedrooms and 4 bathrooms. One bedroom is for staff and kept locked. All the resident bedrooms had the required furnishings and were clean and organized. The garage is used for storage and kept locked. Smoke detectors were tested and are operational. Carbon monoxide detector was tested and is operational. The kitchen was clean and LPA observed the medications are kept in a ktichen cabinet that is kept locked. LPA inspected the first aid kit and it contained all the required elements. LPA observed 2 day perishable and 7 day non-perishable food supply on hand. LPA did not observe any obstacles or hazards in the facility. LPA toured the backyard of the facility. LPA observed a small fountain in the backyard. Backyard exit gate is operational, latched and secured. LPA did not observe any obstacles or hazards in the backyard. Facility is pending mitigation plan approval. No deficiencies are being cited. LPA conducted an exit interview with the Administrator and a copy of the report was provided. Administrator Julieta Milo refused to sign the report. Report signed by LPA and provided to the Administrator.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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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