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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005476
Report Date: 10/23/2024
Date Signed: 10/23/2024 12:20:01 PM

Document Has Been Signed on 10/23/2024 12:20 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:ANGELS CARE GUEST HOMEFACILITY NUMBER:
306005476
ADMINISTRATOR/
DIRECTOR:		JABONERO, JANICEFACILITY TYPE:
740
ADDRESS:10212 MALINDA LANETELEPHONE:
(714) 244-5885
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 6CENSUS: 6DATE:
10/23/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Ruby Lyn Cruz, Quintin Jeffrey Clavecillas, Janice JaboneroTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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An informal conference was conducted on this date in the Orange County Adult and Senior Care Regional Office. The purpose of this informal conference was to discuss concerns regarding the ownership and operation of the licensee GRANNY'S HOMES INC.

Present during this meeting were Regional Manager (RM) Marina Stanic, Licensing Program Manager (LPM) Lourdes Montoya, Licensing Program Analysts (LPAs) Sean Haddad and Eboni Bentley, and GRANNY'S HOMES INC’s Chief Executive Officer (CEO) Quintin Jeffrey Clavecillas, Chief Financial Officer (CFO) Ruby Lyn Cruz, and Administrator (AD) Janice Jabonero.

The purpose of today’s meeting was to discuss the ownership and operation of the licensee GRANNY'S HOMES INC.

During the informal conference, the following items were discussed:
  • The ownership and operation of the licensee GRANNY'S HOMES INC.
  • CEO and CFO will submit to LPA the following documents by close of business October 30, 2024: all bank statements for the licensee GRANNY'S HOMES INC’s bank account from the date the account was opened to the present; certified copies of financial statements for the licensee GRANNY'S HOMES INC from the date of incorporation to the present; and a copy of the board minutes with the decision for the next steps of the licensee GRANNY'S HOMES INC.

An exit interview was conducted and a copy of this report was discussed with and provided to CEO, CFO, and AD.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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