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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006663
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:01:30 PM

Document Has Been Signed on 03/11/2025 03:01 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:A PLACE LIKE HOME 1FACILITY NUMBER:
306006663
ADMINISTRATOR/
DIRECTOR:
AVILA, MARIAFACILITY TYPE:
740
ADDRESS:10291 JULIANA LNTELEPHONE:
(714) 609-2303
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 6CENSUS: 3DATE:
03/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Jasmine Avila - Administrator
Cheramy Tantiado - Assistant Administrator
TIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Jerome Haley arrived to conduct an unannounced Case Management visit. LPA Haley explained the reason for the visit before entering the facility.

After entering the facility, LPA was led on a tour of the facility with staff. There were three residents present at the time of the Case Management visit including Resident 1 (R1). All residents were observed during the visit, two residents were in their bedroom and one resident (R1) was in the living room sleeping.

Staff was asked about R1 during the visit. Both staff present during the visit confirmed, R1 is a happy person, one staff described R1 as a “very lovely woman.” Staff explained R1 is very alert, likes to eat, and takes their medications. R1 gets along with all the staff and the other residents. R1 enjoyed her first bath at the facility.

R1’s nephew has been in contact with facility staff and was here at the facility on Friday, March 7, 2025. Facility staff have not had any problems with the resident.

Staff provided relevant documents for R1 and additional documents will be emailed to LPA Haley.

No deficiencies are being cited as a result of today’s Case Management visit.

An exit interview was conducted, and a copy of this report and LIC811 was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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