<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306003807
Report Date:
12/08/2021
Date Signed:
12/08/2021 12:48:06 PM
Document Has Been Signed on
12/08/2021 12:48 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:
CHATEAU FRANCESCA
FACILITY NUMBER:
306003807
ADMINISTRATOR:
MARIZA OLIVA
FACILITY TYPE:
740
ADDRESS:
33821 VIA CASCADA
TELEPHONE:
(949) 234-0559
CITY:
SAN JUAN CAPISTRANO
STATE:
CA
ZIP CODE:
92675
CAPACITY:
6
CENSUS:
5
DATE:
12/08/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:10 AM
MET WITH:
TIME COMPLETED:
01:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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 explained the reason for the visit. LPA met with Mariza Oliva. Mariza Oliva's Administrator's certificate expires on 5/4/2022. LPA and Administrator toured the facility. Facility has 5 bedrooms and 2 bathrooms. LPA observed all of the resident bedrooms were clean and organized and had the required furnishings. LPA observed the bathrooms were clean and operational and all of the grab bars were secure. Hot water measured 110.1 degrees Fahrenheit in bathroom 1 and 109.2 degrees Fahrenheit in bathroom 2. LPA inspected the kitchen. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. The kitchen is clean and organized. The medications are kept locked in a cabinet. LPA observed knives and sharp objects locked in a kitchen cabinet. LPA observed the fireplace gas line has been capped and the fireplace is empty but there is no fireplace screen. LPA and Administrator toured the backyard. LPA observed a table and chairs and an umbrella in the patio. The storage shed is kept locked and is used for furniture. The exit gates are operational. No obstacles or hazards observed. LPA and Administrator toured the garage. The garage contains the washer and dryer and is used to store extra supplies and food. The garage is kept locked and inaccessible to residents. Smoke detectors/carbon monoxide detectors tested operational. LPA observed all fire extinguishers are fully charged. The first aid kit has all the required elements. 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:
12/08/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1