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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005927
Report Date: 03/21/2022
Date Signed: 03/21/2022 10:52:14 AM

Document Has Been Signed on 03/21/2022 10:52 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ELEONOR'S PLACE 4FACILITY NUMBER:
306005927
ADMINISTRATOR:AVENDANO, DARYLLFACILITY TYPE:
740
ADDRESS:24431 ZANDRA DRIVETELEPHONE:
(949) 547-5377
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 5DATE:
03/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Mark Ryan Cruz, AdministratorTIME COMPLETED:
11:05 AM
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Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Claudia Gutierrez made an unannounced visit to the facility in order to conduct a required annual inspection. LPAs arrived at facility, were greeted and granted entry by caregiving staff after explaining the purpose of the visit and being temperature checked. Administrator Mark Ryan Cruz was called and arrived later to assist with visit.

At approximately 9:35am, LPAs accompanied by administrator toured the inside and outside of the facility. There are currently five (5) residents in care, one of (1) of which is currently on hospice. Residents are observed to be relaxing in their bedroom or in the common areas are appear well taken care of. The bedrooms include all necessary components and sufficient quantity of linen is observed. Both bathrooms are equipped with grab bars and slip mats. Facility appears to be clean, sanitary and free of odors in all areas inspected. Cleaning supplies, sharp instruments and toxic substances are stored in locked cabinets and drawers.

LPAs observed the facility has COVID-19 Precautions posters and required department postings as well as hand washing signs. Facility has an adequate supply of PPE and emergency supplies. A LIC808 Mitigation has been submitted on 07/09/2021.
LPAs observed a sufficient supply of food and water. A 30-day supply of medication is stored and locked in a kitchen cabinet. LPAs toured the outside of the facility. Outdoor furniture is present for the residents' enjoyment in the backyard. The gate byn the side of the house is self-latching and can easily be opened in an evacuation.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. A Technical Advisory is issued in regards to the presence of over-the-counter medication in one of the resident's bathrooms. This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2022
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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