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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000826
Report Date: 09/15/2022
Date Signed: 09/15/2022 09:21:45 AM


Document Has Been Signed on 09/15/2022 09:21 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:AURORA PALMSFACILITY NUMBER:
306000826
ADMINISTRATOR:CAROLYN DUNNFACILITY TYPE:
740
ADDRESS:28282 LA CALETATELEPHONE:
(949) 837-8494
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY:6CENSUS: DATE:
09/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Doug DunnTIME COMPLETED:
09:40 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Kimberly Lyman and Alvaro Ramirez conducted an unannounced closure visit to the facility. LPAs were greeted and granted entry into the facility by Licensee Doug Dunn and explained the reason for the visit.

LPA Lyman was notified via email on July 24, 2022, by licensee, of intent to close facility. LPA received a copy of the letter submitted to residents and responsible parties. Licensee indicates all residents were relocated by August 28, 2022. LPAs toured the facility during the visit and observed no residents on premises and house is currently under construction. Licensee surrendered license to LPAs and was provided a notice of forfeiture of license by LPA. Licensee was advised facility will be closed by LPA in department system.








Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
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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