<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005858
Report Date: 03/29/2022
Date Signed: 03/29/2022 10:38:11 AM


Document Has Been Signed on 03/29/2022 10:38 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:MARKIE'S MANORFACILITY NUMBER:
306005858
ADMINISTRATOR:SMITH, SHELLEEFACILITY TYPE:
740
ADDRESS:13602 YOSEMITE DR.TELEPHONE:
(714) 894-4508
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:6CENSUS: 0DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Shellee SmithTIME COMPLETED:
10:48 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Joseph Alejandre and Jessica Cho made an unannounced visit to conduct the required annual inspection (mitigation). LPAs were greeted and granted entry by Administrator Shellee Smith. Administrator reported and LPAs verified there are no residents at the facility. Facility is a single story home with 5 bedrooms, 2 bathrooms, staff room, kitchen, dining room, living room with a screened fireplace, backyard with a gated swimming pool and a two car attached garage. LPAs and Administrator toured the facility. LPAs observed the stove lights unassisted and the refrigerator is operational, No perishable food observed, LPAs observed non-perishable food on hand. LPAs observed all bedrooms had the required furnishings, Both bathrooms were clean and operational. Hot water measured 120.0 degrees Fahrenheit in bathroom #1 and 129.0 degrees Fahrenheit in bathroom #2. Administrator reported she would adjust the hot water temperature. Hot water temperature adjusted during the visit. LPAs observed a rolling cart that is lockable will be used to store medication and sharp objects. LPAs observed the garage is kept locked and used for storage. LPAs and Administrator toured the backyard. LPAs observed the pool is fenced and the pool gates are locked. LPAs observed the exit gate is locked, Administrator reported that the exit gate will be unlocked when there are residents at the facility. LPAs observed firewood stacked on each side of the house. Facility does not have a mitigation plan on file. Administrator reported she would submit a mitigation plan to LPA Alejandre. 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: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1