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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006163
Report Date: 09/08/2022
Date Signed: 09/08/2022 09:19:33 AM

Document Has Been Signed on 09/08/2022 09:19 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:A+ CARE HOME FULLERTONFACILITY NUMBER:
306006163
ADMINISTRATOR:MCKERNAN, JEANFACILITY TYPE:
740
ADDRESS:2401 THORN PLACETELEPHONE:
(949) 481-6757
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY: 6CENSUS: 0DATE:
09/08/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jean McKernan and Nori WhittakerTIME COMPLETED:
09:35 AM
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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 Jean McKernan. Co-Licensee Nori Whittaker was present as well. An initial application to operate a Residential Care Facility for the Elderly was received by CCL on 03/16/2022 for a capacity of six bedridden residents.

LPA toured the facility at 9:05 AM and observed the following:
  • Water temperature tested between 109.0 and 118.2 degrees F in all restrooms.
  • Facility restrooms have hand washing signs posted.
  • Facility has acquired outdoor, shaded seating in the backyard.

Facility provided an updated floor plan to LPA as requested during visit on 08/24/2022.
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: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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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