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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005858
Report Date: 08/22/2024
Date Signed: 10/02/2024 03:39:33 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/02/2024 03:39 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:MARKIE'S MANORFACILITY NUMBER:
306005858
ADMINISTRATOR/
DIRECTOR:		SMITH, SHELLEEFACILITY TYPE:
740
ADDRESS:13602 YOSEMITE DR.TELEPHONE:
(714) 894-4508
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 6CENSUS: 0DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:13 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
01:48 PM
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Licensing Program Analyst (LPA) Michael Tea attempted to conduct an unannounced annual inspection. Upon arrival no one was home, LPA contacted Administrator Shellee Smith via telephone, no answer and voice mail box was full. LPA texted administrator. No replies. LPA called three times while waiting for someone to appear. There were no residents observed at the facility.

This report will be read and reviewed with administrator once LPA reaches the administrator.

**Administrator signed at Annual Inspection on 10/02/24.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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