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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607410
Report Date: 09/23/2020
Date Signed: 09/23/2020 10:22:17 AM

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:SEVEN SEAS ELDER CAREFACILITY NUMBER:
300607410
ADMINISTRATOR:Z. GLOUNERFACILITY TYPE:
740
ADDRESS:32702 SEVEN SEAS DRIVETELEPHONE:
(949) 248-9415
CITY:DANA POINTSTATE: CAZIP CODE:
92629
CAPACITY:6CENSUS: DATE:
09/23/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:LicenseeTIME COMPLETED:
10:25 AM
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Licensing Program Analysts (LPAs) Kimberly Lyman and Joseph Alejandre contacted the facility via telephone to conduct a case management visit via FaceTime due to COVID-19 and pre-cautionary measures. LPAs identified themselves and discussed the purpose of the call with Licensee.

Licensee submitted written intent to surrender the license for Seven Seas Elder Care on 08/28/2020.


During the visit, LPAs toured the facility via FaceTime and observed no residents residing in the facility. Licensee agrees should she want to reopen the facility at a later date, a new application would need to be submitted and licensee would need to go through the complete application process.

An exit interview was conducted with Licensee via telephone and a copy of this report was provided to
Licensee via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020
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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