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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006134
Report Date: 09/23/2022
Date Signed: 09/23/2022 11:38:58 AM

Document Has Been Signed on 09/23/2022 11:38 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:VIA LA CORUNA MANORFACILITY NUMBER:
306006134
ADMINISTRATOR:MCKEEVER, KAYLAFACILITY TYPE:
740
ADDRESS:23911 VIA LA CORUNATELEPHONE:
(714) 770-7669
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 0DATE:
09/23/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Sean McKeeverTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Jessica Cho made an announced visit for a pre-licensing evaluation. LPA met with Applicant/Licensee Sean McKeever. The facility has four bedrooms and two full bathrooms. This is a single story facility with a two car garage. The inspection is as follows:

A fire clearance was granted on February 17, 2022 for 6 non-ambulatory residents. The Applicant has requested a hospice waiver in between February 15 to April 15, 2022.

LPA toured the interior and exterior of the facility including all resident bedrooms and bathrooms. The hot water temperature was tested in the resident bathrooms and observed to be 108.8 degrees Fahrenheit in Bathroom #1 and 107.2 degrees Fahrenheit in Bathroom #2. One fire extinguisher was mounted and charged but was expired on 11/27/2020. Smoke detectors were centrally wired throughout and have been checked by the fire department. Carbon monoxide detectors are operational including auditory devices. There is sufficient supply of linens, and there are non-skid mats in the showers.

There was one locked closet for medications which included first aid kits. All cleaning equipments were stored in the locked garage. There were several locked closets for storage of toxins and cleaning equipments. All exits have auditory devices except one exit side gate. The kitchen area was checked. The kitchen sink and microwave needs a deep cleaning. Sean McKeever stated that the food menu, activity calendars, theft and loss policy, admission agreement, and emergency plans will be posted. The Complaint Poster (PUB475) did not meet the size requirement. LPA reviewed the outdoor area and there were outdoor furniture under a patio lattice.


Continued LIC809-C...
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: VIA LA CORUNA MANOR
FACILITY NUMBER: 306006134
VISIT DATE: 09/23/2022
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A second pre-licensing will be scheduled.
The following items need to be corrected prior to licensure:

1.) The entire facility needs a deep cleaning mainly in the kitchen sink, microwave, and all showers in the bathrooms including shower curtain rails
2.) Wash all bedding/linens
3.) Replace two of four light bulbs in Bathroom #1
4.) Mattress covers are needed for two beds
5.) A floor lamp is needed for better lighting in the living room
6.) Night lights are needed in the hallway and dining area
7.) Repair auditory device on the exit side gate
8.) Repair left faucet in Bathroom #2
9.) Remove all trash, ladder, and tools in the garage
10.) Remove all debris in front of the main entrance walkway
11.) Enlarge and post the Complaint Poster (PUB475), post the food menu, activity calendars, theft and loss policy, admission agreement, and emergency plans
12.) Please associate Co-Licensee/Administrator Maria McKeever and Administrator Kayla McKeever


Component III was waived because Applicant has other licensed facilities and has already completed Component III.

Facility does not appear ready for licensure. Any items noted during today’s visit are to be corrected by Tuesday, September 27, 2022. LPA Cho will conduct a subsequent Pre-Licensing visit on September 27, 2022 at 9:00am to review the items listed above. An exit interview was conducted with Applicant/Licensee Sean McKeever, and a copy of this report was provided at the time of this visit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
LIC809 (FAS) - (06/04)
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