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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006368
Report Date: 04/22/2024
Date Signed: 04/22/2024 01:42:22 PM

Document Has Been Signed on 04/22/2024 01:42 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:HILLS OF ORCHID, THEFACILITY NUMBER:
306006368
ADMINISTRATOR/
DIRECTOR:		NEPOMUCENO, MARICELFACILITY TYPE:
740
ADDRESS:20271 ORCHID STREETTELEPHONE:
(714) 430-7672
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY: 6CENSUS: 5DATE:
04/22/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Rosendo Carlo MirandaTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the second pre-licensing visit. LPA met with Administrator Rosendo Carlo Miranda and explained the reason for the visit. LPA toured the facility with the Administrator. LPA verified that the evacuation chair has been installed at the top of the staircase to the second floor. No deficiencies observed during the visit.

The facility is ready to be licensed. Administrator was informed today that the final approval will be processed by CAB (Central Applications Bureau) in Sacramento. For more information concerning the pre-licensing inspection visit please see the LIC 809 dated April 19, 2024.

Exit interview was conducted and a copy of this report was left with the Administrator.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2024
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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