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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005946
Report Date: 09/04/2024
Date Signed: 09/04/2024 03:51:42 PM


Document Has Been Signed on 09/04/2024 03:51 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:SERRA SOLFACILITY NUMBER:
306005946
ADMINISTRATOR:LINDSAY SCHROEDERFACILITY TYPE:
740
ADDRESS:31451 AVENIDA LOS CERRITOSTELEPHONE:
(949) 485-2022
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:70CENSUS: 42DATE:
09/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Lindsay ShroederTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a proof of correction visit for deficiency cited during the annual inspection. LPA was greeted and granted entry by staff. LPA met with Executive Director Lindsay Schroeder and explained the reason for the visit. LPA conducted a document review and obtained copies of resident physician reports. LPA verified the 2 residents who did not have a current LIC 602A (physician's report) that both residents have current updated physician's reports. The deficiency has been cleared. The Executive Director has been provided a proof of correction letter.
LPA consulted with the Executive concerning reporting requirements and personal rights.

No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided to the Executive Director.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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