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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002942
Report Date: 07/18/2024
Date Signed: 07/18/2024 11:26:07 AM


Document Has Been Signed on 07/18/2024 11:26 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:NIGUEL HILLS VILLA IIFACILITY NUMBER:
306002942
ADMINISTRATOR:RHODORA GULLANDFACILITY TYPE:
740
ADDRESS:24965 VIA LARGATELEPHONE:
(949) 573-3203
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 2DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Rhodora GullandTIME COMPLETED:
11:38 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Rhodora Gulland and explained the reason for the visit. LPA and the Administrator toured the facility. Facility is a one story house with Facility has 5 bedrooms and 2 bathrooms. 3 bedrooms are for residents, living room with a screened fireplace, kitchen, dining room and a two car garage. LPA observed the See Something, Say Something poster is posted in the dining room. LPA and Administrator toured the resident rooms. LPA observed all resident rooms had the required furnishings and bed linens. LPA observed both bathrooms are clean and operational. Hot water measured 122.0 degrees Fahrenheit. The hot water was adjusted to lower temperature setting during the visit. LPA observed the gas cook top stove lights unassisted. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. Smoke detectors and carbon monoxide detectors tested operational. LPA and the Administrator toured the backyard and garage. The garage is kept locked and used for storage. The backyard has shaded seating area for residents to sit outside. No bodies of water observed. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPA inspected the first aid kit, the first aid kit had all the required elements. LPA reviewed 2 resident files. No discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. LPA consulted with the Administrator concerning reporting requirements. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2024
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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