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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003850
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:36:51 PM

Document Has Been Signed on 03/09/2023 03:36 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:WHISPERING OAKS - WAVERLYFACILITY NUMBER:
306003850
ADMINISTRATOR:IMELDA C. CAROFACILITY TYPE:
740
ADDRESS:14782 WAVERLY LANETELEPHONE:
(714) 931-1945
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 6CENSUS: 5DATE:
03/09/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:16 PM
MET WITH:Gasparina Lofranco - Caregiver TIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Whispering Oaks - Waverly. LPA Velazquez was allowed entry into the facility and met with Caregiver Gasparina Lofranco. The purpose of today's visit was to conduct a Plan of Correction visit for previously issued deficiencies that have not been corrected and a Repeat Violation had been issued.

HSC 1569.652(c) Termination of Admission Agreement Upon Death of a Resident, removal of resident’s property; refund of fees paid; notice of contract termination and refunds. (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. During the Case Management visit dated March 1, 2023 the aforementioned was issued and the POC due date was March 2, 2023. On today's visit the citation has yet to be cleared. A civil penalty is being issued for a Repeat Violation in the amount of $250.00.


An exit interview was conducted with Caregiver Gasparina Lofranco and a copy of this report along with the Civil Penalty and Appeal Rights were provided at the time of this visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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