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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005866
Report Date: 11/15/2021
Date Signed: 11/15/2021 04:15:56 PM

Document Has Been Signed on 11/15/2021 04:15 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:ELEONOR'S PLACE 2FACILITY NUMBER:
306005866
ADMINISTRATOR:AVENDANO, DARYLLFACILITY TYPE:
740
ADDRESS:24772 ARGUS DRIVETELEPHONE:
(949) 547-5377
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 6DATE:
11/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Reiner AvendanoTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was screened for symptoms of Covid-19 and allowed entry. LPA explained the reason for the visit. Daryll O Avendano, the Administrator of record, Administrator's certificate expires on 3/28/22. Licensee Reiner Avendano arrived at 3:10 pm. LPA and Licensee toured the facility. LPA observed the living room fireplace was screened. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. LPA observed the kitchen is clean and organized. LPA inspected the first aid kit. First aid kit had all the required elements. LPA observed all of the bedrooms had the required furnishings. LPA observed all of the restrooms were clean and operational. LPA and Licensee toured the garage. The garage is kept locked and inaccessible to residents. The garage can only be entered from outside of the house. The garage is used for storage. LPA and Licensee toured the backyard. No bodies of water observed. The backyard has a table and chairs with an umbrella for residents to sit outside. No obstacles or hazards observed in the backyard. The exit gate is operational. Facility has a mitigation plan that is pending approval. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2021
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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