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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005769
Report Date: 06/23/2022
Date Signed: 06/23/2022 09:46:43 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/23/2022 09:46 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:ADAIR LOVING CAREFACILITY NUMBER:
306005769
ADMINISTRATOR:ADAIR, ROBERTFACILITY TYPE:
740
ADDRESS:23665 CREMONATELEPHONE:
(949) 228-6285
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 0DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Robert AdairTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced required annual inspection focusing primarily on the Infection Control. At 9:02 am, LPA was greeted and granted entry by Licensee/Administrator (Admin) Robert Adair and stated the purpose of the visit. LPA was informed by the Admin that the facility has not accepted any residents since facility was licensed due to renovations. Facility has a total of three bedrooms and is adding on four additional bedrooms. LPA consulted with Admin to inform the primary LPA once the facility is ready to accept residents.

As of today, the annual licensing fees are current.

LPA reviewed the approved COVID-19 mitigation plan of the facility. No deficiency cited in this review as per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Licensee/Administrator Robert Adair, and a copy of this report was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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