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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004399
Report Date: 03/23/2024
Date Signed: 03/23/2024 05:05:50 PM


Document Has Been Signed on 03/23/2024 05:05 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:QUALITY SENIOR LIVINGFACILITY NUMBER:
306004399
ADMINISTRATOR:MARIA DOLORES D TENTEFACILITY TYPE:
740
ADDRESS:24262 GRASS STREETTELEPHONE:
(949) 215-3087
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 5DATE:
03/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:46 PM
MET WITH:Felijun Casuyon - House ManagerTIME COMPLETED:
05:20 PM
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced case management visit to the facility. LPA explained the purpose of today's visit, and met with house manager (HM) Felijun Casuyon.

During this visit, LPA conducted a follow up for a report received on 3/6/24. LPA conducted a tour of the facility and observed that there were no health and safety concerns noted.

LPA conducted an interview with HM Casuyon and facility administrator (AD) Maria Tente via phone call regarding the incident.

For this visit, no citations were issued.

An exit interview was conducted with HM Casuyon.

A copy of this report was provided and explained.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2024
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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