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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004376
Report Date: 01/26/2026
Date Signed: 01/26/2026 12:42:25 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/26/2026 12:42 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:IRVINE CARE HOMEFACILITY NUMBER:
306004376
ADMINISTRATOR/
DIRECTOR:		CRISTINA EVANGELISTAFACILITY TYPE:
740
ADDRESS:41 BETHANYTELEPHONE:
(949) 861-3178
CITY:IRVINESTATE: CAZIP CODE:
92603
CAPACITY: 6CENSUS: 4DATE:
01/26/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Milani Villasis DSP (Direct Support Staff) TIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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On today's date, Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by caregiver staff, LPA explained the purpose for the visit. Administrator (AD) Cristina Evangelista was notified via telephone and could not arrive to assist due to being at a doctor's appointment. LPA observed that Cristina Evangelista has a valid Administrator certificate which expires on April 27, 2026. LPA Vanegas began a tour of the facility and observed the following.

The facility is a single-story house and consists of the following. Seven bedrooms four of which are private resident bedrooms, two of which are staff bedrooms, three shared resident bathrooms, a living room, a dining room, a kitchen, a courtyard, and an attached two car garage. LPA Vanegas observed two residents in care, lounging in the living room area. LPA Vanegas observed three caregiver staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall in the dining room measured 20 X 26 inches. LPA Vanegas inspected the four resident bedrooms, and they were observed to be free of any hazards. LPA Vanegas observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, a reading lamp, and enough storage space for personal belongings. All resident beds had clean linens in good repair meaning no strains or tares. LPA observed additional linens are stored in a hallway closet. LPA inspected the three shared resident bathrooms, and observed resident bathrooms to be clean and free of any mildew and debris. Bathrooms are equipped with grab bars and slip resistant floor mats. Faucets and toilets were operational, and hot water temperature measured between 107.9 and 114.8 degrees Fahrenheit. LPA observed the two staff bedrooms are kept locked and inaccessible to residents in care.

CONTINUED ON LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 7
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: IRVINE CARE HOME
FACILITY NUMBER: 306004376
VISIT DATE: 01/26/2026
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LPA Vanegas observed kitchen area to be clean, and free of any mildew or debris. LPA Vanegas observed a dishwasher, microwave, gas stove, and refrigerator. Refrigerator was observed to be at the appropriate temperature, and all appliances tested operational. LPA Vanegas observe a two day supply of perishable food and a seven day supply of non-perishable food, as well as a sufficient amount of emergency water and emergency food in the case of a natural disaster.

LPA Vanegas observed the outside of the facility to be free of debris and hazards a long exit routes. LPA Vanegas observed side doors to be self latching and unlocked. LPA Vanegas observed an outdoor shaded sitting area, and for the backyard to be large enough to participate in outdoor activities upon resident request. LPA Vanegas observed all smoke detectors and carbon monoxide detectors to be operational. LPA Vanegas observed all fire extinguishers to be fully charged and up to date.

LPA Vanegas reviewed P&I with DSP Milani Villasis. All balances were accurate and documented accordingly. LPA Vanegas reviewed three staff files, and four resident files. All files (Resident and Staff) had all required documents and all annual staff training was complete. LPA Vanegas reviewed medication administration log and medications for all four clients. No discrepancies were observed.

Based on observations made during today's inspection no deficiencies will be issued per title 22 division 6 of the California Code of Regulations. An exit interview was conducted with DSP Milani Villasis and a copy of this report was provided to the facility, furthermore a copy of this report will be mailed to the facility.
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC809 (FAS) - (06/04)
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