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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006263
Report Date: 03/05/2025
Date Signed: 03/05/2025 04:10:17 PM

Document Has Been Signed on 03/05/2025 04:10 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GRANNY'S PLACE #6FACILITY NUMBER:
306006263
ADMINISTRATOR/
DIRECTOR:		NESBITT, MICHELLEFACILITY TYPE:
740
ADDRESS:26722 PEPITATELEPHONE:
(949) 533-5938
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 0DATE:
03/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:03 PM
MET WITH:Kimberly Arnett, Assistant Administrator (via phone)TIME VISIT/
INSPECTION COMPLETED:
03:04 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the required annual inspection. Upon arriving on the premises, LPA observed the facility to be vacant. No response was made upon knocking on the facility's door.

LPA then called Assistant Administrator Kimberly Arnett. Assistant Administrator confirmed that the facility was still undergoing remodeling and was not admitting residents at this time. It was additionally confirmed that there were no residents currently admitted or staff assigned to working at this licensed location at this time.

LPA agreed to provide licensee with a copy of the present report via email before it could be signed and returned. Licensee is reminded of the necessity to inform the Department of its intent to resume admitting residents so a facility inspection can be conducted.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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