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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005231
Report Date: 10/25/2022
Date Signed: 10/25/2022 03:24:02 PM

Document Has Been Signed on 10/25/2022 03:24 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:GRAND VIEW VILLAFACILITY NUMBER:
306005231
ADMINISTRATOR:AMNALI, ROZINAFACILITY TYPE:
740
ADDRESS:26701 GRANVIA DRIVETELEPHONE:
(949) 600-7218
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 4DATE:
10/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Taj Amlani, Administrator TIME COMPLETED:
03:40 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering an amended complaint investigation report (LIC9099-A) regarding the complaint referenced 22-AS-20220204135802.

LPA was greeted and granted entry by caregiving staff after explaining the purpose of the visit. Administrator Taj Amlani was notified of the visit by telephone and arrived shortly afterwards. LPA went over the modifications made to the initial report on form LIC9099-A and provided a printed copy of the signed amended report along with this facility visit report which were both left at facility. An exit interview was also provided to facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2022
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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