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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306001402
Report Date:
11/01/2021
Date Signed:
11/01/2021 11:32:17 AM
Document Has Been Signed on
11/01/2021 11:32 AM
- 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:
ALICIA CARE
FACILITY NUMBER:
306001402
ADMINISTRATOR:
SAEED, MUHAMMAD ANWAR
FACILITY TYPE:
740
ADDRESS:
29742 ANA MARIA
TELEPHONE:
(949) 249-6610
CITY:
LAGUNA NIGUEL
STATE:
CA
ZIP CODE:
92677
CAPACITY:
6
CENSUS:
4
DATE:
11/01/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:30 AM
MET WITH:
Muhammad Anwar Saeed
TIME COMPLETED:
11:37 AM
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Licensing Program Analyst (LPA) Joseph Alejandre. made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA was screened for symptoms of Covid-19. LPA observed all staff were wearing masks. LPA met with Administrator Muhammad Anwar Saeed. LPA and Administrator toured the facility. LPA observed the kitchen is clean and has a 2 day perishable and 7 day non-perishable food supply on hand. LPA observed all fire extinguishers are fully charged. LPA observed all medication is kept locked in a kitchen cabinet. The smoke detectors/carbon monoxide detectors tested operational. LPA observed all the bedrooms had the required furnishings. The garage is used for storage and inaccessible to residents. LPA observed extra supplies stored in the garage. LPA toured the backyard. The exit gate is operational. The covered patio has chairs for the residents to sit. No bodies of water observed. The metal shed in the backyard is used for storage and inaccessible to residents. Facility has a mitigation plan that has been approved. 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:
11/01/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/01/2021
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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