<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005889
Report Date:
11/15/2021
Date Signed:
11/15/2021 02:02:01 PM
Document Has Been Signed on
11/15/2021 02:02 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:
DEL'S HAVEN II
FACILITY NUMBER:
306005889
ADMINISTRATOR:
MANALO, DIANNA
FACILITY TYPE:
740
ADDRESS:
29251 VIA SAN SEBASTIAN
TELEPHONE:
(949) 258-2063
CITY:
LAGUNA NIGUEL
STATE:
CA
ZIP CODE:
92677
CAPACITY:
6
CENSUS:
5
DATE:
11/15/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:51 PM
MET WITH:
Dianna Manalo
TIME COMPLETED:
02:15 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 Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Administrator Dianna Manalo arrived at 1:25 PM. Facility has 5 bedrooms and 2 bathrooms. LPA and Administrator toured the facility. LPA observed all resident bedrooms had the required furnishings. All the bedrooms had enough space to accommodate each resident and their belongings. LPA observed both showers had anti-skid mats. LPA observed both bathrooms were clean and operational. LPA and the Administrator toured the garage. LPA observed the garage is used for storage and is inaccessible to residents. LPA observed the kitchen is clean and organized. LPA observed the gas stove top is operational. LPA observed there is a 2 day perishable food supply and a 7 day non-perishable food supply on hand. LPA observed the fire extinguisher in the kitchen is fully charged. The smoke/carbon monoxide detectors tested operational. LPA and the Administrator toured the backyard. No bodies of water observed. LPA observed a table under the awning with chairs for residents to sit outside. No obstacles or hazards observed in the backyard. The exit gate is operational. The first aid kit has all the required elements. The facility has a mitigation plan that has been approved. 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)
Page:
1
of
1