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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005694
Report Date: 11/06/2024
Date Signed: 11/06/2024 12:31:54 PM

Document Has Been Signed on 11/06/2024 12:31 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:DEL'S HAVENFACILITY NUMBER:
306005694
ADMINISTRATOR/
DIRECTOR:
MANALO, DIANNAFACILITY TYPE:
740
ADDRESS:29835 ANDREA WAYTELEPHONE:
(949) 418-3222
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
11/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:04 AM
MET WITH:Dianna ManaloTIME VISIT/
INSPECTION COMPLETED:
11:04 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Dianna Manalo and explained the reason for the visit. Dianna Manalo's Administrator's Certificate expires November 15, 2025.

LPA and the Administrator toured the facility. The facility is a single story home with 6 bedrooms (1 for staff and 5 for residents), 3 bathrooms, kitchen, dining room, living room with a screened fireplace and a two car garage which is kept locked and used for storage. LPA observed the See Something, Say Something sign. Puzzles and games are stored in the living room under the large screen TV. LPA observed a 2 day perishable and 7 day non-perishable food supply in the kitchen, Knives are kept locked in a ktichen drawer. Cleaning supplies are kept locked under the kitchen sink. The fire extinguisher in the dining room is fully charged. LPA observed all resident rooms had the required furnishings and linens. LPA observed that 3 out of 5 resident had bed rails. All 3 residents had the proper physician's orders for bed rails. LPA observed all 3 bathrooms are clean and operational, hot water measured 107.6 degrees Fahrenheit in all bathrooms. LPA and the Administrator toured the backyard. There is a fountain in the backyard that is fenced. There is a shaded patio with tables and chairs to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. The smoke detectors and carbon monoxide detectors tested operational. LPA observed the first aid kit has all the required elements.

LPA reviewed 5 resident records and medications, no discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed.

No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
Sheila SantosTELEPHONE: (714) 334-2062
Joseph AlejandreTELEPHONE: 714-705-6018
DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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