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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005511
Report Date: 07/14/2021
Date Signed: 07/14/2021 02:26:14 PM

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:MILESTONE ELDER CAREFACILITY NUMBER:
306005511
ADMINISTRATOR:KONTAR, JOHNFACILITY TYPE:
740
ADDRESS:25142 LAS BOLSASTELEPHONE:
(949) 742-0247
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 0DATE:
07/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Kristen FowlerTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced case management visit for the purpose to verify all residents have been relocated in order for the facility closure. LPA arrived at facility was greeted at the door by Kristen Fowler, facility representative and granted entry. LPA explained the nature of today’s visit. LPA spoke with John Kontar, Administrator via telephone call and advised of the visit.

LPA received notification by John Kontar, Administrator that there was no longer an interest in keeping facility open. LPA advised Administrator that a final inspection would have to be done to verify all residents have been relocated prior to closure of facility. On 06/30/2021 LPA made a case management visit to verify all residents were relocated, however it was observed there were still 2 residents in facility. LPA advise both John Kontar, Administrator and Levita Hogan, caregiver that all residents needed to be relocated and not until then could the facility be closed. LPA was notified on 07/13/2021 by Levita Hogan, caregiver that all residents had been relocated. The Administrator advised LPA that on 04/04/2021 he mailed renewal signed verifying he had no interest in renewing the license.

LPA toured the facility and observed no residents in care. LPA observed the home to be empty and found no evidence the home is operating as a licensed facility. Based on observation, the facility is no longer operating as a licensed facility and is closed.

This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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