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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005965
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:46:47 PM

Document Has Been Signed on 10/16/2024 04:46 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:OHANA BOARD AND CAREFACILITY NUMBER:
306005965
ADMINISTRATOR/
DIRECTOR:		UJIMORI, TROYFACILITY TYPE:
740
ADDRESS:25422 PACIFICA AVETELEPHONE:
(949) 807-2336
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 4DATE:
10/16/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:29 PM
MET WITH:Troy Ujimori, administratorTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit to the facility for the purpose of continuing the annual inspection initiated on October 10, 2024. LPA was greeted and granted entry by licensee and administrator Troy Ujimori after stating the purpose of the visit. During the initial visit, LPA had been unable to measure the hot water due to a plumbing intervention in progress during most of the inspection.

During the present visit, LPA measured the water temperature to be 105.4F. No further items need to be reviewed at this time.

Based on the observations conducted during today's visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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