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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005700
Report Date: 05/19/2023
Date Signed: 05/19/2023 10:13:04 AM


Document Has Been Signed on 05/19/2023 10:13 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:DEL SOL I RSLFACILITY NUMBER:
306005700
ADMINISTRATOR:MAYORGA, JONATHANFACILITY TYPE:
740
ADDRESS:26462 VIA DEL SOLTELEPHONE:
(949) 357-6255
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 0DATE:
05/19/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Jonathan Mayorga-AdministratorTIME COMPLETED:
10:28 AM
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On 05/19/23 Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an unannounced collateral visit in conjunction with complaint 22-AS-20201119083021. LPA Ramirez was allowed entry into the facility and met with Administrator (AD) Jonathan Mayorga and explained the purpose of the visit.

LPA Ramirez reminded AD Mayorga that a follow up complaint visit will be made to Mission II RSL.

An exit interview was conducted with AD Mayorga and a copy of this report was provided at the time of exit.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2023
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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