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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005898
Report Date: 01/27/2025
Date Signed: 01/27/2025 11:36:15 AM

Document Has Been Signed on 01/27/2025 11:36 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ELEONOR'S PLACE 3FACILITY NUMBER:
306005898
ADMINISTRATOR/
DIRECTOR:		AVENDANO, DARYLLFACILITY TYPE:
740
ADDRESS:26711 VALPARISO DRIVETELEPHONE:
(949) 547-5377
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 6DATE:
01/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Licensee Daryll AvendanoTIME VISIT/
INSPECTION COMPLETED:
11:52 AM
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Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by caregiver staff after explaining the purpose for the visit. Licensee Daryll Avendano, House Manager (HM) Mark Cruz, and Office Manager (OM) Kelsey Choi were notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Eleonor Avendano has a valid Administrator certificate which expires on October 29, 2025.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents with a hospice waiver for four. The facility is a single story home with four resident bedrooms, two of which are shared and two of which are private, one staff room, two shared resident bathrooms, a living room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by the HM conducted a tour of the physical plant. On today's visit, LPA observed six residents in care and two caregiver staff present. LPA observed residents relaxing in the living room and in the dining room. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the entryway of the facility. LPA inspected the four resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the two shared resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 114.6 and 114.9 degrees Fahrenheit. LPA observed the staff room is kept locked and inaccessible to residents in care.

LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed kitchen knives are stored in a locked kitchen cabinet. CONTINUED ON LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ELEONOR'S PLACE 3
FACILITY NUMBER: 306005898
VISIT DATE: 01/27/2025
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A fire extinguisher is located in the hallway by the kitchen, and it was observed the be charged and serviced as of April 5, 2024. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 13, 2025. The centrally stored medication is kept in a locked closet by the kitchen. LPA observed the facility has a three day emergency food and water supply stored in the locked closet by the kitchen. LPA observed a First Aid kit to be stored in the dining room. LPA observed the First Aid Kit has all the required components. The door leading to the attached two car garage is kept locked and inaccessible to resident. The garage is used for storage and laundry. LPA observed chemicals to be stored in the locked two car garage.

LPA and HM conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the southside of the facility is self-latching and can be opened in an evacuation. There are no bodies of water on the premises.

LPA reviewed the six resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed six residents’ medication and medication records. LPA reviewed two staff files. All staff are background cleared and associated to the facility.

Based on today's observations, there are no deficiencies being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Licensee Daryll Avendano, House Manager Mark Cruz, and Office Manager Kelsey Choi, and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC809 (FAS) - (06/04)
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