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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006446
Report Date: 07/16/2024
Date Signed: 07/16/2024 03:17:47 PM

Document Has Been Signed on 07/16/2024 03:17 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:PERPETUAL LOVE SENIOR LIVINGFACILITY NUMBER:
306006446
ADMINISTRATOR/
DIRECTOR:
JIMENEZ, FREGILFACILITY TYPE:
740
ADDRESS:18480 SANTA ALBERTA CIRCLETELEPHONE:
(714) 332-7051
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 6CENSUS: 5DATE:
07/16/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Fregil JimenezTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Edward Kim made an announced visit to conduct the second pre-licensing inspection. LPA Kim was greeted and granted entry by Applicant Fregil Jimenez. LPA Kim explained the reason for the visit upon entry. The first pre-licensing inspection was made on July 1, 2024 and several corrections were needed.

The applicant requested a capacity of 6 nonambulatory residents and of which one (1) bedridden. Applicant has requested a hospice waiver for two (2) residents. The facility is a one story house in a residential neighborhood with an attached 2 car garage with five (5) bedrooms, of which four (4) bedrooms are for residents and one bedroom (1) is for staff, two (2) full bathrooms, family room, dining room, a kitchen, and living room with a screened fireplace



During a tour of the facility, LPA Kim observed that the following items have been corrected:

1) Furnace has been replaced and has been approved by Socalgas.

2) Electric stove front left burner is operable.

All items have been corrected. No new deficiencies were observed. The facility is ready for licensure.

The pre-licensing visit and Component III Orientation are now complete. It appears this facility meets the requirements for licensure. LPA Kim will forward this report to the Centralized Applications Bureau for review. The license will be granted upon completion of a final review and approval from the Centralized Applications Bureau.



An exit interview was conducted and a copy of this report was provided to applicant Fregil Jimenez.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
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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