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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004410
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:41:35 PM


Document Has Been Signed on 02/28/2024 02:41 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:PRIORITY CARE SENIOR LIVINGFACILITY NUMBER:
306004410
ADMINISTRATOR:RAFAEL/JOSEPHINE TEEHANKEEFACILITY TYPE:
740
ADDRESS:23762 SAN ESTEBANTELEPHONE:
(949) 305-9870
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
02/28/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Veronica BellezaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 02/13/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit.

Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has been cleared. Items in the yard have been removed, exit gate is repaired and fire extinguisher is fully charged.. Licensee has complied with the POC.

Advisory note dated 02/23/2024 advised facility to conduct a fire drill for quarter 4. Facility provided documentation of fire drill conducted on 12/01/2023.









Exit interview conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024
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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