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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006134
Report Date: 09/27/2022
Date Signed: 09/27/2022 11:49:47 AM

Document Has Been Signed on 09/27/2022 11:49 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: DATE:
09/27/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Sean McKeeverTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Jessica Cho conducted an announced visit to Via La Coruna Manor. LPA Cho was allowed entry into the facility and met with Applicant/Administrator Sean McKeever . The purpose of today's subsequent Pre-Licensing visit was to follow-up on the issues that were present during the initial Pre-Licensing visit dated 09/23/2022. The following issues were observed and required correction:

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
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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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: 09/27/2022
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On today's visit the aforementioned items have been addressed and corrected. The aforementioned items reviewed during this visit are in compliance. The Pre-Licensing is now complete. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. Applicant/Administrator Sean McKeever was reminded of the statute that requires them to notify the Department within 5 business days of admitting the first resident. This notification may be done by phone, mail, email, or fax. An exit interview was conducted with Applicant/Administrator 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: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
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