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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001585
Report Date: 04/27/2023
Date Signed: 04/27/2023 01:41:03 PM


Document Has Been Signed on 04/27/2023 01:41 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:LAKEVIEW HOMES MISSION VIEJOFACILITY NUMBER:
306001585
ADMINISTRATOR:ALFONSO VENTURAFACILITY TYPE:
740
ADDRESS:23036 SONOITATELEPHONE:
(949) 583-1213
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:4CENSUS: 4DATE:
04/27/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Beverlie Moya, Albert YusikeeTIME COMPLETED:
01:55 PM
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of a health and safety check and to follow up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 04/24/23. LPA met with Staff #1 (S1) Beverlie Moya and Staff #2 (S2) Albert Yusikee and explained the purpose of the inspection. Administrator (AD) Peter Ventura appeared via telephone.

During the inspection, LPA and S2 toured the facility. LPA observed there were 2 staff present. LPA observed 3 residents present. LPA conducted health and safety checks on the 3 residents present and confirmed they were doing well and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed the electricity and water were running, the medications were properly stored, and the facility had soap and paper towels. LPA requested and reviewed copies of the resident roster, staff roster, resident files, and staff files.

Facility representative was advised that at this time further investigation is required. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023
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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