<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306001485
Report Date:
10/31/2023
Date Signed:
10/31/2023 03:35:30 PM
Document Has Been Signed on
10/31/2023 03:35 PM
- 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:
SAN CLEMENTE VILLAS BY THE SEA
FACILITY NUMBER:
306001485
ADMINISTRATOR:
LAURA KEPHART
FACILITY TYPE:
740
ADDRESS:
660 CAMINO DE LOS MARES
TELEPHONE:
(949) 489-3400
CITY:
SAN CLEMENTE
STATE:
CA
ZIP CODE:
92673
CAPACITY:
190
CENSUS:
135
DATE:
10/31/2023
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
02:00 PM
MET WITH:
Cara Deiro
TIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on citation issued on 10/19/2023. LPA was greeted and granted entry into the facility and explained the reason for the visit.
*Deficiency cited under Title 22 Regulation 87464(f)(1) pertaining to Basic Services has been cleared. Licensee provided proof of correction. Licensee has complied with the POC.
Licensee has been advised to maintain compliance in all items previously cited
An exit interview was conducted and a copy of this report was provided at exit.
SUPERVISOR'S NAME:
Alisa Ortiz
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Kimberly Lyman
TELEPHONE:
(714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE:
10/31/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1