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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005503
Report Date: 07/20/2023
Date Signed: 07/20/2023 11:16:54 AM


Document Has Been Signed on 07/20/2023 11:16 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
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:A MISSION CHATEAU LLCFACILITY NUMBER:
306005503
ADMINISTRATOR:MCKEEVER, MARIAFACILITY TYPE:
740
ADDRESS:25011 DE SALLE STTELEPHONE:
(562) 207-7216
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 4DATE:
07/20/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Carla MirandaTIME COMPLETED:
11:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ruth Martinez conducted this unannounced Case Management visit on today’s date. LPA arrived at facility was greeted and granted entry by staff. Carla Miranda, Administrator arrived shortly after and met with LPA.

LPA explained to administrator that the facility annual fees of $742 was due on December 27, 2022. LPA informed administrator that on October 05, 2022, Community Care Licensing Division (CCLD) sent the bill to the mailing address on record. LPA Martinez on April 19, 2023, spoke to Maria McKeever, Administrator and provided the annual fee amount information and a PIN to pay fees online. Administrator Mckeever advised LPA Martinez that fees would be paid immediately. On June 15, 2023, LPA Martinez received notification that annual fees had not been paid, LPA contacted Maria McKeever, Administrator via telephone call and was unable to leave a message due to voicemail being full. LPA Martinez emailed Administrator to email on record that records indicate that fees had not been paid.

LPA explained to Carla Miranda, Administrator that per regulation section 87156(a)(e) Licensing Fees and per Health and Safety Code §1569.185 Fees for license or applications; use of revenues; collected; denial or forfeiture: the failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. LPA informed administrator that the annual licensing fees can be paid online at http://www.ccld.ca.gov/. In an effort to assist with a prompt payment, LPA provided a PIN number, which can be used to pay the balance immediately at CCLD website.

Based on this inspection, deficiencies were observed per Title 22 Division 6 of the California Code of Regulations. See LIC 809-D for deficiencies.

This report was reviewed with facility representative and a copy of this LIC809, LIC809-D report was provided and left at facility. Appeal rights reviewed, and a copy provided.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023
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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Document Has Been Signed on 07/20/2023 11:16 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868


FACILITY NAME: A MISSION CHATEAU LLC
FACILITY NUMBER: 306005503

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2023
Section Cited
CCR
87156(a)(e)

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Licensing Fees.(a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185.(e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license.
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Adminsitrator shall pay the facility's deliquient annual licensing fee of $742.00, and provide LPA with proof of the full payment by the POC date 07/23/23.
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This requirement was not met as evidence by, annual licensing fees due date was 12/27/23; however; the administrator did not pay the annual fees by the due date and for this reason, a late fee was also accrued. This causes an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023
LIC809 (FAS) - (06/04)
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