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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006270
Report Date: 04/12/2023
Date Signed: 04/12/2023 09:13:46 PM

Document Has Been Signed on 04/12/2023 09:13 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:IRVINE COTTAGE #7FACILITY NUMBER:
306006270
ADMINISTRATOR:NESBITT, MICHELLEFACILITY TYPE:
740
ADDRESS:40 CYPRESS TREE LANETELEPHONE:
(949) 533-5938
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY: 6CENSUS: 6DATE:
04/12/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Michelle NesbittTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Lydia Martinez conducted this announced continuation of Pre-licensing visit to ensure the facility made the necessary correction required from the Pre-licensing visit inspection on 03/ 27/2023. LPA Martinez met with Designated Administrator Michelle Nesbitt and both toured the facility.

Applicant was to submit a new floor plan to match facility structure.

During the inspection on 03/27/2023, LPA Martinez noted that the application’s approved Orange County Fire Authority (OCFA) Fire Clearance did not match the structure. Caretaker room has a built in partition wall that was not marked on the floor plan that was approved by OCFA on 12/16/2022. LPA Martinez contacted OCFA Inspector who agreed to re-visit the facility and double check. OCFA conducted the visit and cleared the facility on 03/24/2023. LPA received copy of approved floor plan on 04/05/2023.

The item identified for correction during initial Pre-licensing visit of 03/27/2023 is now corrected. With the above correction completed the facility's physical plant meets requirements of Title 22 Regulations.

All items reviewed during the visit are in compliance. Facility appears to be ready for licensure based on LPA's evaluation. An exit interview was conducted with Designated Administrator and a copy of this report will be sent to email on file.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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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