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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005844
Report Date: 04/13/2022
Date Signed: 04/13/2022 02:21:17 PM


Document Has Been Signed on 04/13/2022 02:21 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
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: 0DATE:
04/13/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Geraldina CelisTIME COMPLETED:
02:31 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Joseph Alejandre, Jessica Cho and Celine De Perio made an announced visit to conduct a case management visit. LPA Alejandre met with Administrator Geraldina Celis. LPA explained the reason for the visit. The Agency received reports the facility was closed. LPAs toured the facility. LPAs observed there were no residents or staff at the facility. LPAs verified that no residents are living at the facility. Administrator reported the facility is closed for renovations but the Licensee does not wish to surrender the license because they plan to reopen the facility once the renovations are complete. LPA advised Administrator to report all proposed changes in writing to the Agency for approval before moving forward. Administrator stated she understood. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2022
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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