<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006297
Report Date: 02/04/2025
Date Signed: 02/04/2025 11:33:59 AM

Document Has Been Signed on 02/04/2025 11:33 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:DEL'S HAVEN IVFACILITY NUMBER:
306006297
ADMINISTRATOR/
DIRECTOR:
MANALO, DIANNAFACILITY TYPE:
740
ADDRESS:23822 STILLWATER LANETELEPHONE:
(949) 258-2063
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 6DATE:
02/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Dianna ManaloTIME VISIT/
INSPECTION COMPLETED:
11:46 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Dianna Manalo and explained the reason for the visit. Dianna Manalo's Administrator's Certificate expires November 15, 2025. The facility is licensed for 6 non-ambulatory residents of which 1 may be bedridden and a hospice waiver for 4.

LPA and the Administrator toured the facility. The facility is a single story home with 5 bedrooms , 2 bathrooms, kitchen, dining room, living room with a screened fireplace and a three car garage which is kept locked and used for storage. The garage has a storage room/office which is kept locked. LPA observed the See Something, Say Something sign posted in the main entrance of the facility. The last emergency drill was conducted on January 17, 2025. The smoke detectors/carbon monoxide detectors tested operational. The fire extinguishers in the hallway and dining room are fully charged. Puzzles and games are stored in the living room under the large screen TV. LPA observed the kitchen is clean and operational. The 5 burner gas stove lights unassisted. LPA observed a 2 day perishable and 7 day non-perishable food supply in the kitchen, Knives are kept locked in a ktichen drawer. Cleaning supplies are kept locked under the kitchen sink. . LPA observed all resident rooms had the required furnishings and linens. LPA observed both (2) bathrooms are clean and operational, hot water measured 111.3 degrees Fahrenheit in both (2) bathrooms. LPA and the Administrator toured the backyard. No bodies of water observed. There is table with an umbrella and chairs to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPA observed the first aid kit has all the required elements. Facility has an internet device (Tablet) for dedicated resident use.

LPA reviewed 6 resident records and medications, no discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. Both staff members have the required training. Both staff members are background cleared and associated to the facility. 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: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1