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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005769
Report Date: 07/10/2024
Date Signed: 07/10/2024 11:06:46 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/10/2024 11:06 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: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:
07/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Robert AdairTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing a 1 year required inspection. LPA arrived at facility was greeted at the door by Robert Adair, Administrator and granted entry. During today’s visit, LPA explained the reason for visit. LPA toured the facility and inspected the physical plant of the facility; no residents were observed at facility. LPA was informed there are no residents currently residing at facility and only occupant is administrator. LPA observed that facility is being renovated and is currently being worked on. LPA was notified earlier this year that the garage had been converted to a bedroom and added on to the footprint of the facility. LPA received a new footprint of the facility with conversion and was informed Licensee was coordinating with Fire Authority for the approval of the conversion. Administrator is taking the proper channels for the revision and once completed LPA will do a final inspection. LPA was informed that nothing has changed with the facility since last annual of 2022 and facility has no residents since it was licensed. Licensee will contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents or if there are any changes with the license. As a reminder LPA gave information for annual fees due to be paid to Administrator.

At this time there were no deficiencies to report in the facility. As noted above, Licensee will contact CCLD once residents are being admitted. In an effort to update the facility file, the Administrator is required to submit to the licensing agency a copy of the following:

- An updated Personnel Report (LIC500).

- Copy of Administrator Certificate.

This report was reviewed with administrator and a copy of this LIC809 report was provided

SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024
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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