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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005713
Report Date: 06/13/2024
Date Signed: 06/13/2024 08:02:26 AM


Document Has Been Signed on 06/13/2024 08:02 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 COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:B&C SENIOR LIVINGFACILITY NUMBER:
306005713
ADMINISTRATOR:ESTORBA, BRIANFACILITY TYPE:
740
ADDRESS:10269 CLAUDIA AVETELEPHONE:
(714) 488-8413
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:6CENSUS: 0DATE:
06/13/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:John Jason EugenioTIME COMPLETED:
08:10 AM
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Licensing Program Analyst (LPA) Jerome Haley conducted a case management visit to verify facility closure. LPA Haley met with Administrator John Jason Eugenio and explained the reason for the visit. During the visit LPA Haley toured the facility to verify the facility is empty and all residents have been relocated.

During the tour, LPA Haley observed all five bedrooms, common areas, the backyard, and garage. LPA observed the home to be empty and found no evidence the home is operating as a licensed facility and is now closed.

At the end of the tour, the facility license was surrendered as a part of the closing process.

An exit interview was conducted and copy of this report was provided.

SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024
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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