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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005866
Report Date: 05/20/2022
Date Signed: 05/20/2022 12:56:16 PM

Document Has Been Signed on 05/20/2022 12:56 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: DATE:
05/20/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Juan GarciaTIME COMPLETED:
01:00 PM
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Licensing Program Analyst(LPA) Michelle Reed arrived at the facility to conduct a Collateral visit. The visit was conducted to interview Resident #1 in regards to Complaint #22-AS-20210205142629. Upon arrival, LPA met with Staff Juan and Teresita Garcia. There were 6 residents present. Residents were finishing lunch and in their rooms resting. Administrator Mark Cruz was contacted by Mr. Garcia and then again by LPA. Mr. Cruz gave permission for Juan Garcia to sign this report.

Resident #1 was interviewed privately in her room.

An exit interview was conducted and a copy of this report was provided to Juan Garcia.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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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