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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005503
Report Date: 12/04/2024
Date Signed: 12/04/2024 02:27:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/04/2024 02:27 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:A MISSION CHATEAU LLCFACILITY NUMBER:
306005503
ADMINISTRATOR/
DIRECTOR:		MCKEEVER, MARIAFACILITY TYPE:
740
ADDRESS:25011 DE SALLE STTELEPHONE:
(562) 207-7216
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:33 PM
MET WITH:Carla Miranda-wardTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at facility was greeted at the door by administrator and granted entry.

During today’s visit, LPA met with Administrator Carla Miranda and explained the nature of the visit. LPA toured the facility and inspected the physical plant of the facility; no residents were observed at facility. LPA was informed there are no residents currently residing at facility and only occupant is administrator. LPA was informed the facility had 2 residents and they were moved to another licensed facility on November 07, 2024. Licensee will contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents or if there are any changes with the license. LPA as a reminder provided annual fee dues information.

At this time there were no deficiencies to report in the facility. As noted above, Licensee will contact CCLD once residents are being admitted. In an effort to update the facility file, the Administrator is required to submit to the licensing agency a copy of the following:

- An updated Personnel Report (LIC 500).

- Copy of Administrator Certificate.

This report was reviewed with administrator and a copy of this LIC809 report was provided

Armando J LuceroTELEPHONE: (949) 430-1222
Ruth MartinezTELEPHONE: (657) 285-1397
DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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