<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005570
Report Date: 11/02/2022
Date Signed: 11/02/2022 11:50:05 AM

Document Has Been Signed on 11/02/2022 11:50 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SAN GIOVANNI BOSCO RESIDENTIAL CAREFACILITY NUMBER:
306005570
ADMINISTRATOR:JOHN PIRAINOFACILITY TYPE:
740
ADDRESS:24596 DARDANIA AVETELEPHONE:
(949) 583-9143
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 3DATE:
11/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Dina Piraino, Darlene PirainoTIME COMPLETED:
12:05 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 Analysts (LPAs) Jessica Cho and Michelle Reed made an unannounced visit for the purpose of a case management visit to check on the operation of the facility and the health and safety of the residents. LPAs were greeted and granted entry by Caregiver Nestor Angeles. Licensee Dina Piraino was also present. A tour of the physical plant was conducted with Caregiver Angeles. The Licensee's Daughter Darlene Piraino, arrived approximately around 11:25am. Darlene Piraino will provide a plan for future operation of the facility by Friday, November 4, 2022.

No deficiency cited at this time of Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Licensee Darlene Piraino, and a copy of this report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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