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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005718
Report Date: 01/22/2025
Date Signed: 01/22/2025 04:27:19 PM

Document Has Been Signed on 01/22/2025 04:27 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:MIRAGE MANOR HOME CAREFACILITY NUMBER:
306005718
ADMINISTRATOR/
DIRECTOR:		GARCIA,MARIAFACILITY TYPE:
740
ADDRESS:1630 W CRIS AVETELEPHONE:
(714) 956-1005
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/22/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:26 PM
MET WITH:Maria GarciaTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On January 22nd, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting a plan of correction visit. Upon arrival LPA Vanegas was greeted and granted entry by Care Giver (CG) Maria Garcia. LPA Vanegas was able to obtain proof of correction for previous citations given during last annual inspection.

CG Garcia provided proof of updated staff training, and per LPA Vanegas review staff is trained and it is documented. Per LPA Vanegas review medications are being documented correctly and being administered per physician orders. Plan of corrections for each citation have been cleared.

Based on observations during today's plan of correction visit no citations will be issued per tittle 22 chapter 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
Armando J LuceroTELEPHONE: (714) 703-2866
William VanegasTELEPHONE: (714) 497-7621
DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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