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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002155
Report Date: 03/21/2022
Date Signed: 03/21/2022 01:49:40 PM

Document Has Been Signed on 03/21/2022 01:49 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:BRANDON MANORFACILITY NUMBER:
306002155
ADMINISTRATOR:MARY YEPESFACILITY TYPE:
740
ADDRESS:28421 BRANDON DR.TELEPHONE:
(949) 365-9082
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 5CENSUS: 4DATE:
03/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Mary YepesTIME COMPLETED:
02:10 PM
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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 Administrator Mary Yepes. LPA explained the reason for the visit. Administrator's certificate expires on 12/29/2023. LPA and Administrator toured the facility. Facility has 4 bedrooms, 2 bathrooms, dining room, living room, kitchen, family room with a screened fireplace and a 2 car garage. Smoke Detectors and Carbon Monoxide detectors tested operational. First Aid kit has all the required elements. LPA observed a 20 X 26 inch PUB 475 poster (See Something, Say Something poster) in the entrance way of the facility. LPA observed all medication are kept locked in a kitchen cabinet. LPA observed knives and cleaning supplies are kept locked under the kitchen sink. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand in the kitchen. Hot water measured 109.9 degrees Fahrenheit in bathroom one and 106.0 degrees Fahrenheit in bathroom two. Both bathrooms are clean and operational. LPA observed all resident bedrooms had the required furnishings. LPA and Administrator toured the garage. The garage is kept locked and used for storage. The backyard has a covered patio with a table and chairs for residents to sit outside. The exit gates on each side of the house are operational. There is a small gazebo and a small fountain that has no water in it. Administrator reported that the backyard is being landscaped and there will be additional sprinklers and more drought tolerant plants. Administrator reported that at this time residents are not allowed to use the backyard until all of the work is completed. Administrator reported that residents who want to go outside are taken to the front porch where there is a covered sitting area. Administrator reported that residents are always with a caregiver when outside. Facility has a mitigation plan that is pending review. No deficiencies observed during the visit. 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: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2022
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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