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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003937
Report Date: 06/23/2023
Date Signed: 06/23/2023 11:10:23 AM


Document Has Been Signed on 06/23/2023 11:10 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:LOS TIEMPOS SENIOR LIVINGFACILITY NUMBER:
306003937
ADMINISTRATOR:ROSA FIGUEROAFACILITY TYPE:
740
ADDRESS:17935 LOS TIEMPOS STREETTELEPHONE:
(714) 964-6310
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
06/23/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lesly Figueroa and Rosa Figueroa, Licensee Representative TIME COMPLETED:
11:10 AM
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An informal virtual meeting was held via Microsoft teams. The purpose of today's meeting was to discuss the facility solvency audit investigation.

Present during the meeting were: Licensing Program Manager (LPM) Alisa Ortiz, Licensing Program Analyst (LPA) Rosie Quiroz, Regional Manager (RM) Marina Stanic, Jessica Chen, General Auditor III, Jaqueline Juarez, Supervising Governmental Auditor I, Licensee representatives Lesly Figueroa and Rosa Figueroa.

The purpose of today's virtual Informal meeting was to discuss the Solvency Audit Request letter addressed to facility dated May 9, 2023 and provided consultation to Licensee representatives Lesly Figueroa and Rosa Figueroa on the requirement to provide requested documents.

During the meeting, both licensee representatives stated they had not received the email and letter and requested an extension to provide requested documents.

It was agreed by all parties that an extension would be granted until July 21, 2023.


A copy of this report was provided to Licensee representative Lesly Figueroa via email and an electronic email read receipt confirms receiving these documents.


SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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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