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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006260
Report Date: 03/21/2025
Date Signed: 03/21/2025 11:42:08 AM

Document Has Been Signed on 03/21/2025 11:42 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:IRVINE COTTAGE #1FACILITY NUMBER:
306006260
ADMINISTRATOR/
DIRECTOR:		ARNETT, KIMBERLYFACILITY TYPE:
740
ADDRESS:1 LONGSTREETTELEPHONE:
(949) 533-5938
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY: 6CENSUS: 0DATE:
03/21/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:18 AM
MET WITH:Kimberly Arnett- Administrator
Michelle Nesbitt - Compliance Manager
Jozeff Springer- Executive Administrator 		TIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a case management. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The facility had remolded the home and had a completed and approved fire clearance inspection on 03/4/2025. The facility is licensed for 6 non-ambulatory residents. The facility currently has zero residents. LPA Mendivil toured the facility and reviewed current floor plan. Facility is a single story home with 6 resident bedrooms , 1 staff room and 3 bathrooms.

Based on today's observations no deficiencies noted.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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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