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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004713
Report Date: 07/18/2024
Date Signed: 07/18/2024 10:24:34 AM


Document Has Been Signed on 07/18/2024 10:24 AM - 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:PACIFICARE HOMEFACILITY NUMBER:
306004713
ADMINISTRATOR:EMELITA MAGDALUYOFACILITY TYPE:
740
ADDRESS:24622 JEREMIAH DRIVETELEPHONE:
(949) 489-2273
CITY:DANA POINTSTATE: CAZIP CODE:
92629
CAPACITY:6CENSUS: DATE:
07/18/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Emelita MagdaluyoTIME COMPLETED:
10:22 AM
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An Informal Conference was held on this date at the Orange County Adult and Senior Care Regional Office via Teams.

At this informal conference, present were: Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst Kimberly Lyman and Licensee Emelita Magdaluyo.

The following was discussed at the meeting:

  • Decision and Order for Staff 1.
  • Licensee agrees to disassociate the staff in the Guardian System.







Exit interview conducted and a copy of this report will be emailed to Licensee.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2024
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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