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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006625
Report Date: 02/24/2025
Date Signed: 02/24/2025 10:55:26 AM

Document Has Been Signed on 02/24/2025 10:55 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:RISE AND SHINE VILLA PARKFACILITY NUMBER:
306006625
ADMINISTRATOR/
DIRECTOR:		GAVRILAS, ALEXANDRAFACILITY TYPE:
740
ADDRESS:17872 PORTSMOUTH CIRCLETELEPHONE:
(949) 549-9190
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY: 6CENSUS: DATE:
02/24/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Alexandra GavrilasTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Samer Haddadin made an announced visit to the facility today to conduct a Prelicensing visit. LPA was greeted and granted entry by Administrator (AD) Alexandra Gavrilas.

The facility is a one-story home with 5 bedrooms and four restrooms The facility has an approved fire clearance of five ambulatory residents and one none ambulatory; facility had no residents in care at the time of visit.
During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature all four restrooms, and testing audio devices on all exits. The hot water temperature measured between 118.8- and 119.6-degrees Fahrenheit, and all smoke detectors were operational. The fire extinguisher is charged with a proof of purchase of September 23nd, 2024.
LPA inspected the exterior of the facility; no bodies of water observed. Facility has enough outside space for activity. LPA Checked emergency exits and all were cleared and free of obstacles.
LPA inspected the facility food supply and observed the facility retained seven days of non-perishable food on hand and will have two days of perishable items once there are residents in care. Knives and cleaning supplies are secured in a separate cabinet located in the kitchen.
LPA observed the PUB 475 is posted in the required 20" X 26" size. Visiting hours were posted. LPA confirmed that administrator has a current administrator certificate which expires on January 16th, 2027. LPA conducted Component III with Administrator.
LPA observed medication storage and a First Aid Kit with all the required components and medication storage is locked. LPA observed all required department posting hung by the entrance...
The Administrator was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted, and a copy of the report was provided to Licensee.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
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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