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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000351
Report Date: 06/30/2021
Date Signed: 06/30/2021 03:35:21 PM

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:QUALITY LIFE HOMES #2FACILITY NUMBER:
306000351
ADMINISTRATOR:THOMAS SATHERFACILITY TYPE:
740
ADDRESS:23962 HILLHURST DRIVETELEPHONE:
(949) 249-3428
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 4DATE:
06/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Thomas Sather & Carmencita EspiniliTIME COMPLETED:
03:47 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by Administrator Carmencita Espinili. Carmencita Espinili's administrator's certificate expires on 2/9/2022. LPA and the Administrator toured the facility. Facility has 7 bedrooms and 5 bathrooms. Thomas Sather arrived after the visit began. One bedroom is for staff and kept locked. The garage is used for storage and kept locked. Smoke detectors were tested and are operational. The garage contains extra supplies of cleaning products and food. LPA observed 2 day perishable and 7 day non-perishable food supply on hand. LPA did not observe any obstacles or hazards in the facility. LPA toured the backyard of the facility. No bodies of water observed. Backyard has a table with an umbrella for shade for residents to sit outside. Both backyard exits are latched and secured. LPA did not observe any obstacles or hazards in the backyard. LPA reviewed the mitigation plan with the Administrator and informed her that it must have comments in each section under the check boxes explaining how the facility will complete the required tasks listed in the mitigation plan (LIC 808). Administrator stated she understood. Thomas Sather departed the facility at 3:25 pm. LPA informed Administrator that the new updated mitigation plan (LIC 808) is due by 5:00pm July 2, 2021. Administrator stated she understood. No deficiencies are being cited. LPA conducted an exit interview with the Administrator and a copy of the report was provided to the Administrator.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
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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