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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006148
Report Date: 12/16/2022
Date Signed: 12/16/2022 03:22:52 PM

Document Has Been Signed on 12/16/2022 03:22 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GRAND VIEW VILLAS INC.FACILITY NUMBER:
306006148
ADMINISTRATOR:AMLANI, ROZINAFACILITY TYPE:
740
ADDRESS:25262 VIA DE ANZATELEPHONE:
(714) 348-4793
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 6DATE:
12/16/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Rozina AmlaniTIME COMPLETED:
03:47 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the post licensing visit. LPA was greeted and granted entry by staff. LPA met with Administrator Rozina Amlani. LPA explained the reason for the visit. LPA and Administrator toured the facility. Facility is a single story home with 7 bedrooms, 7 bathrooms, kitchen, dining room, living room and an attached 2 car garage that is being used for storage and kept locked. LPA observed the fireplace in the living room is screened. LPA observed the See Something Say Something poster (PUB 475) is posted in the entry way of the facility. LPA and Administrator toured the backyard. There is a patio cover for the residents with a table and chairs to sit. Both exit gates are operational. There is a small raised fountain in the backyard. The fountain is raised and has a small water depth so it doesn't pose a risk to residents. No obstacles or hazards observed in the backyard. LPA and Administrator toured the inside of the facility. All resident rooms are private single occupancy rooms. LPA observed all resident rooms had the required furnishings. LPA observed all resident bathrooms were clean and operational. Hot water measured 112.2 degrees Fahrenheit. LPA observed all medications and the first aid kit are stored locked in the hall closet. LPA observed all knives and sharp objects are kept stored in a locked kitchen drawer. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day perishable food supply on hand in the kitchen. LPA and Administrator toured the garage. The garage is kept locked and used for storage. LPA observed extra furniture, supplies and food stored in the garage. Smoke detectors/carbon monoxide detectors tested operational. All fire extinguishers are fully charged and were inspected on 9/26/22. LPA consulted with the Administrator concerning continued Covid-19 mitigation and reporting requirements. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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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