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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005844
Report Date: 10/28/2022
Date Signed: 10/28/2022 05:37:07 PM


Document Has Been Signed on 10/28/2022 05:37 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:
10/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:40 PM
MET WITH:Geraldina CelisTIME COMPLETED:
05:46 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. No one was present at the facility when LPA arrived, LPA contacted the Administrator Geraldina Celis and informed her of the visit. Administrator reported that she would be at the facility shortly, Administrator arrived at the facility at 5:00 pm. and reported that the facility currently has no residents and is undergoing minor updates, LPA and Administrator toured the facility. LPA verified there are no residents and no staff present at the facility and no evidence anyone is residing at the facility. LPA informed the Administrator that she must notify the Agency (CCL) prior to accepting new residents. Administrator stated she understood. LPA observed all the resident rooms had the required furnishings but had no personal belongings stored in any room. All bathrooms were clean and operational. LPA observed the facility had electricity, gas and water and the facility landline phone number is 949-429-2511 and it is operational. LPA and Administrator toured the backyard,. There is a covered patio and a seating area to sit outside,. No bodies of water observed, Both exit gates are operational, No obstacles or hazards observed inside or outside of the facility, No deficiencies observed during the visit, No deficiencies are being cited as a result of this visit, 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: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
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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