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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004440
Report Date: 09/16/2024
Date Signed: 09/16/2024 01:49:42 PM


Document Has Been Signed on 09/16/2024 01:49 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:VILLA AT PLEASANT HILLS, THEFACILITY NUMBER:
306004440
ADMINISTRATOR:CASEY VILLAVERDEFACILITY TYPE:
740
ADDRESS:938 JOYCE DRIVETELEPHONE:
(714) 582-2345
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:6CENSUS: 0DATE:
09/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Casey Villaverde, AdministratorTIME COMPLETED:
02:00 PM
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LIcensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility at 1:30PM. LPA was greeted and granted entry by Casey Villaverde. The purpose of the visit is to confirm the facility has no residents. The facility has been closed since July 2022. Residents were relocated to nearby Assisted Living facilities or moved with family.

LPA confirmed there are no residents residing in the home and that he Administrator is surrendering facility license. Administrator was informed that a new application would need to be submitted to our department in order to operate as a Residential Care Facility for the Elderly (RCFE). Licensee could not locate paper license for signature.

An exit interview was conducted with Casey Villaverde, Administrator and a copy of the report was given at the time of the visit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: RoseMarie RuppertTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024
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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