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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004596
Report Date: 10/11/2023
Date Signed: 10/11/2023 04:27:12 PM

Document Has Been Signed on 10/11/2023 04:27 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:JON ADULT RESIDENTIAL CARE HOMEFACILITY NUMBER:
306004596
ADMINISTRATOR:LEONCIO CANLASFACILITY TYPE:
735
ADDRESS:3801 LARIAT PLACETELEPHONE:
(714) 770-0892
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY: 6CENSUS: 3DATE:
10/11/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lora Aquino- Office Manager
Jon Castro- Vice President 		TIME COMPLETED:
04:30 PM
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Community Care Licensing (CCL) staff met with Vice President Jon Castro and Office Manager Lora Aquino to discuss the findings of a solvency audit report dated 09/07/2023. The meeting was held with Regional Manager Reyna Lacey, Regional Manager Marina Stanic, Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst Jenifer Tirre, General Auditors Jessica Chen & Xia Ni. .

The solvency audit was a result of the Department being notified of a consent judgment against the licensee. The audit findings report was reviewed with the Licensee, as well as the facility's finances and operational expenses. The audit found the licensee is generating sufficient income to meet the operating costs. It was further determined that the licensee's finances would not be affected by the Department of Labor judgement. However, there is not a sufficient fund reserve in the business checking account to cover any unforeseen expenses.

The Licensee was notified the facility would be placed on quarterly financial monitoring for a period of one year. Financial records for the months of August through October 2023 are due by 11/01/2023. The documents to include in the financial records are bank statements, utility bills, mortgage payment and food receipts. Licensee Representative is to provide Department with monthly detailed plan of Quality Assurance Review beginning 11/01/2023

This report was discussed and a copy provided to Facility Representative.
SUPERVISORS NAME: Shelly Grace
LICENSING EVALUATOR NAME: Alisa Ortiz
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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