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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000351
Report Date: 05/03/2022
Date Signed: 05/03/2022 11:51:46 AM


Document Has Been Signed on 05/03/2022 11:51 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: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: 6DATE:
05/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Carmencita EspiniliTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA met with Administrator Carmencita Espinili. LPA explained the reason for the visit. LPA and Administrator toured the facility. LPA observed the fireplace in the living room is screened. LPA observed the PUB 475 poster (See Something, Say Something poster) is in the kitchen and is 8 1/2 by 11 inches. Facility is a single story home that has 7 bedrooms 5 bathrooms, kitchen, dining room, living room and a 3 car garage. One bedroom and one bathroom is for staff only. LPA observed all resident bedrooms had the required furnishings. LPA observed all the bathrooms are clean and operational. Hot water measured 116.0 degrees Fahrenheit. LPA observed the kitchen is clean and organized. LPA observed all fire extinguishers are fully charged. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen.The smoke detectors and carbon monoxide detectors tested operational. LPA and staff toured the garage. The garage is kept locked and used for storage. The backyard has an exit gate on each side. Both exit gates are latched and operational. No bodies of water observed. There is a seating area in the backyard consisting of a table with an umbrella and 4 chairs. No obstacles or hazards observed in the backyard. Facility has submitted a mitigation plan. Plan is pending approval. No deficiencies observed. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
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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