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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003564
Report Date: 10/01/2024
Date Signed: 10/01/2024 09:04:47 AM


Document Has Been Signed on 10/01/2024 09:04 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:JUST LIKE HOME IIFACILITY NUMBER:
306003564
ADMINISTRATOR:ROBERT MASSUCOFACILITY TYPE:
740
ADDRESS:10265 SHERWOOD CIRCLETELEPHONE:
(714) 532-4405
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY:6CENSUS: 6DATE:
10/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Alicia LiraTIME COMPLETED:
09:25 AM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Just Like Hone II for the annual inspection. LPA was greeted and granted entry into the facility and explained the reason for the visit.


Upon review, facility just underwent a pre-licensing on 09/10/2024 for a change of ownership. No annual required at this time pending licensure.











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: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024
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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