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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004168
Report Date: 10/29/2020
Date Signed: 11/12/2020 08:45:33 AM

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:LANEY'S COTTAGESFACILITY NUMBER:
306004168
ADMINISTRATOR:THUY N DAVISFACILITY TYPE:
740
ADDRESS:3383 LARKSPUR STREETTELEPHONE:
(714) 754-6826
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: 0DATE:
10/29/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:34 PM
MET WITH: Licensee Elayne S Carver TIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Shobhana Frank conducted a Case Management virtual tele-visit due to COVID-19 and for pre-cautionary measures for the purpose to verify facility closure. LPA spoke with Licensee Elayne S Carver and discussed the purpose of the virtual tele-visit.

On 10/21/2020 Licensee Elayne S Carver informed LPA frank that She would like to close her facility as she moved all 3 residents, to Laney’s Cottages Mesa Verde, licensee number 306004837 on 10/18/20. Laney's Cottages Licensee number 306004168 has been vacant since 10/18/20. The facility is no longer operating as a licensed facility. The Licensee agrees to surrender license by mail at 770 The City Drive, Orange CA 92868 to Licensing office by 11/3/20. The reason for today's inspection is to confirm the closure of the licensed facility.
LPA toured the facility via What's App and observed no residents in care. LPA observed the home to be empty and found no evidence the home is operating as a licensed facility. Based on observation, the facility is no longer operating as a licensed facility and is closed today on 10/29/20. During today’s visit, no deficiencies were noted in areas inspected.
An exit interview was conducted with Licensee Elayne S Carver via virtual tele-visit and a copy of this report was provided to Licensee Elayne S Carver via email. An electronic email read receipt or response to email indicating as received as confirmation. Licensee agrees to send a signed copy by email.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Shobhana FrankTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020
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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