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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006406
Report Date: 08/15/2024
Date Signed: 08/15/2024 10:01:53 AM

Document Has Been Signed on 08/15/2024 10:01 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:HILLS OF BROADWAY, THEFACILITY NUMBER:
306006406
ADMINISTRATOR/
DIRECTOR:		MIRANDA, ROSENDO CARLOFACILITY TYPE:
740
ADDRESS:354 BROADWAYTELEPHONE:
(714) 430-7672
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 6CENSUS: 6DATE:
08/15/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Maricel Nepo Muceno- Applicant
Rosendo Miranda-Administrator		TIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Jessica Cho conducted an announced subsequent Pre-Licensing visit to follow-up on the issues that were present during the initial visit on August 6, 2024. LPA Cho was allowed entry and met with Applicant Maricel Muceno and Administrator Rosendo MIranda. The following items required correction:
  • To deep clean the kitchen appliances, inside the refrigerator/freezer, kitchen drawers/pantries, entire floor, and all bathrooms including showers.
  • To treat stains/spots on furniture.
  • To organize and remove clutter in the garage.
  • To repair the leak from the garage refrigerator, install a missing drawer handle in the kitchen drawer, holes in the hallway(s)
  • To spot treat/paint the walls, doors, and kitchen cabinetry

On today's visit the aforementioned items have been addressed and corrected. The items reviewed during this visit are in compliance. The Pre-Licensing is now complete. The licensee will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau.

Component III is waived due to the applicant operating licensed facilities and having completed Component III. LPA provided a refresher consultation in the initial answering questions for the Applicant. This concludes the Pre-Licensing inspection.

An exit interview was conducted with Applicant Maricel Muceno and Administrator Rosendo Miranda, and a copy of this report was provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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