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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606831
Report Date: 07/18/2022
Date Signed: 07/18/2022 09:58:15 AM


Document Has Been Signed on 07/18/2022 09:58 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:FREEDOM VILLAGEFACILITY NUMBER:
300606831
ADMINISTRATOR:MARIANNE CASINO/ J.NIBLETTFACILITY TYPE:
741
ADDRESS:23442 EL TORO ROADTELEPHONE:
(949) 472-4733
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:533CENSUS: 99DATE:
07/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Administrator - Joel NiblettTIME COMPLETED:
10:17 AM
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Licensing Program Analyst (LPA) Celine De Perio met with Facility Administrator (AD) Joel Niblett, Assistant Director Jackie Arreaga, and Clinical Director Jean Guevara to conduct an unannounced case management visit to follow up on the technical assistances issued on 7/7/2022 regarding the following:
  • Delayed egress doors are temperamental when opening. Please ensure doors are easily operational at all times - COMPLETED. All delayed egress doors are operational, as it alarms and automatically opens within 15 seconds when pushed.
  • Emergency Disaster Plan (LIC 610) - COMPLETED and posted in a central location.
  • PUB 475 "Let Us Know" Poster - COMPLETED and posted.

Note: Per AD, the PUB 475 poster size: "20 X 26" was ordered and a copy of a receipt was provided. Pending delivery.

An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2022
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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