<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006103
Report Date: 04/05/2022
Date Signed: 04/05/2022 10:24:01 AM

Document Has Been Signed on 04/05/2022 10:24 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:CASA FRANCESCAFACILITY NUMBER:
306006103
ADMINISTRATOR:OLIVA, MARIZAFACILITY TYPE:
740
ADDRESS:2942 CALLE GRANDE VISTATELEPHONE:
(949) 240-6889
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY: 6CENSUS: 4DATE:
04/05/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mariza OlivaTIME COMPLETED:
10:20 AM
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) Kimberly Lyman made an announced visit to conduct a follow up pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Administrator/ Licensee Mariza Oliva. An initial application to operate a Residential Care Facility for the Elderly was received by CCL on 10/15/2021 for a capacity of five non-ambulatory residents and 1 bedridden. Facility has a covid screening area in the entrance of the facility and LPA self screened upon entry.

At 10:10 AM, LPA toured the facility and observed the following:
  • French sliding doors have been repainted.
  • Kitchen cupboards have been repainted.








Facility is ready to be licensed.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
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