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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005844
Report Date: 09/09/2020
Date Signed: 09/09/2020 04:47:54 PM

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:BLUE SKIES OF LAGUNA NIGUELFACILITY NUMBER:
306005844
ADMINISTRATOR:CELIS, GERALDINA PFACILITY TYPE:
740
ADDRESS:25437 VIA ESTUDIOTELEPHONE:
(949) 326-0311
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 5DATE:
09/09/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Geraldina CelisTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Joseph Alejandre contacted the applicant via FaceTime to conduct the second Pre-Licensing visit due to Corona virus precautions. LPA was greeted and granted entry by applicant Geraldina Celis. LPA and applicant toured the facility and LPA observed bathroom 2 has now been repaired and is cleared of building materials. LPA observed the shower is operational, the shower door has been reinstalled and the extra tiles are gone. LPA observed the toilet and faucet are working and there was no extra items in the bathroom other than soap, paper towels and toilet papers. LPA informed applicant that the pre-licensing visit has been completed and the application process will be completed by the CAB specialist. LPA informed applicant the final application decision will be completed by the CAB specialist who would notify the applicant by mail. Applicant stated she understood. Exit interview conducted and this report was emailed to applicant (email read receipt verifies applicant received report). Applicant agreed to send a signed copy of the report back to the LPA.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020
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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