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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005647
Report Date: 10/31/2024
Date Signed: 10/31/2024 03:05:51 PM

Document Has Been Signed on 10/31/2024 03:05 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:PACIFIC SUN SENIOR CAREFACILITY NUMBER:
306005647
ADMINISTRATOR/
DIRECTOR:		DADABHOY, MUQEETFACILITY TYPE:
740
ADDRESS:24532 SPARTAN STREETTELEPHONE:
(949) 600-5346
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/31/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:55 PM
MET WITH:Christopher Martinez- CaregiverTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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Licensing Program Analysts (LPAs) Jessica Cho and Ebony Bentley made a subsequent visit for the purpose of issuing a civil penalty in connection to the Type A Fire Clearance citation issued today during the annual inspection at 12:20. Administrator Muqueet Dadabhoy was notified by telephone explaining the reason for the civil penalty.

Immediate civil penalty LIC421IM is being assessed.

An exit interview was conducted with Caregiver Christopher Martinez (authorized by Administrator Dadabhoy), and a copy of this report along with the LIC421IM were provided at the end of the visit.
Lourdes MontoyaTELEPHONE: (714) -70-2870
Jessica ChoTELEPHONE: 714-703-2853
DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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