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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005334
Report Date: 07/11/2023
Date Signed: 07/11/2023 01:41:21 PM


Document Has Been Signed on 07/11/2023 01:41 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:WONDER'S YEARSFACILITY NUMBER:
306005334
ADMINISTRATOR:JUAN M. GARCIA TRUJILLOFACILITY TYPE:
740
ADDRESS:24301 BARK STREETTELEPHONE:
(949) 215-4087
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 2DATE:
07/11/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Facility Staff- Mariadelos Trujillo Cruz TIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 06/02/2023. LPA De Perio explained reason for visit, was greeted and granted entry by facility staff (S1) Mariadelos Trujillo Cruz, who notified facility administrator (AD) Juan Garcia Trujillo.

On 06/02/22 facility failed to issue a resident a refund. Deficiency cited under Title 22 Regulation 87507(5)(c) pertaining to Admission Agreements has been CLEARED. On 07/01/23, AD Trujillo issued resident a refunded check with the agreed upon amount. Licensee has complied with the terms of the POC.

An exit interview was conducted with S1.

A copy of this report was provided and explained.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023
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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