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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001079
Report Date: 04/11/2022
Date Signed: 04/11/2022 02:51:46 PM

Document Has Been Signed on 04/11/2022 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ABSOLUTE CAREFACILITY NUMBER:
306001079
ADMINISTRATOR:VLADIMIR KRAVCHENKOFACILITY TYPE:
740
ADDRESS:24651 PALACE CT.TELEPHONE:
(949) 249-6894
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 1DATE:
04/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Vladimir KravchenkoTIME COMPLETED:
03:09 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annuaul inspection (mitigation). LPA was greeted and granted entry by Administrator Vladimir Kravchenko. LPA explained the reason for the visit. LPA interviewed resident 1. Administrator's certificate expires 2/5/2023. LPA and Administrator toured the facility. Facility has 4 bedrooms, 3 bathrooms, living room, dining room, kitchen, family room and a garage. LPA observed that R1's room had all the required furnishings. LPA observed all bathrooms were clean and operational. LPA did not observe the PUB 475 poster posted by the entrance. LPA observed the fireplace in the living room and family room are both screened. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand in the kitchen. Smoke detectors tested operational. The garage is kept locked and used for storage. LPA and Administrator toured the backyard. LPA observed there is an in ground hot tub that is covered. The wood cover can be walked on and easily supports the weight of an adult. The exit gate is latched and operational. No obstacles or hazards observed inside or outside of the facility. Facility has a mitigation plan that is pending approval. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2022
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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