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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002155
Report Date: 03/17/2025
Date Signed: 03/17/2025 11:34:35 AM

Document Has Been Signed on 03/17/2025 11:34 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:BRANDON MANORFACILITY NUMBER:
306002155
ADMINISTRATOR/
DIRECTOR:
MARY YEPESFACILITY TYPE:
740
ADDRESS:28421 BRANDON DR.TELEPHONE:
(949) 365-9082
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 5CENSUS: 2DATE:
03/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Mary YepesTIME VISIT/
INSPECTION COMPLETED:
11:31 AM
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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 Mary Yepes, her Administrator certificate expires on December 29, 2025. The facility is a single story home with 4 bedrooms, 2 bathrooms, living room, dining room, kitchen and a family room with a screened fireplace, laundry room and an attached two care garage.. The fireplace is place is empty and the Administrator reported it is not used. The facility is licensed for 5 non-ambulatory residents of which 1 may be bedridden and a hospice waiver for 2. LPA and the Administrator toured the facility. LPA observed a two day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed knives and sharp objects are kept locked under the kitchen sink. The fire extinguisher in the kitchen is fully charged. Medications are kept locked in a kitchen cabinet. The fire extinguisher in the kitchen is fully charged. LPA observed both bathrooms are clean and operational. Hot water measured 119.2 degrees Fahrenheit. Smoke detectors/carbon monoxide detectors tested operational. The garage is kept locked and used for storage. LPA observed all resident rooms had the required furnishings. LPA and Administrator toured the backyard. There is a table and chairs in the backyard for sitting outside. The patio is covered and there is a small gazebo. LPA observed a small raised fountain. Both exit gates are operational. LPA reviewed 2 resident files and medication, no discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed, both staff members have the required training and CPR/First-Aid training. Both staff members are background cleared and associated to the facility. The last fire drill was conducted on February 3, 2025. LPA inspected the first aid kit. The first aid kit has all the required elements. No deficiencies observed during the visit. LPA consulted with the Administrator concerning reporting requirements, Guardian background clearances and volunteers.

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: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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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