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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005952
Report Date: 02/23/2024
Date Signed: 02/23/2024 11:53:46 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/03/2024 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240103152625
FACILITY NAME:BLUE SKIES OF LAGUNA HILLSFACILITY NUMBER:
306005952
ADMINISTRATOR:GAMAB, RAFAEL ABRENICAFACILITY TYPE:
740
ADDRESS:25811 TREE TOP RD.TELEPHONE:
(619) 208-7869
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 4DATE:
02/23/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Bryant So - Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee abandoned facility
INVESTIGATION FINDINGS:
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On this Day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Shy Balignasay and explained the reason for the visit. Administrator Bryant So arrived at the faciltiy at 11:30am.

The Department received a complaint on 01/03/2024 and LPA Mendivil conducted the initial visit on 01/11/2024. LPA Mendivil interviewed staff and current Licensee, as well as obtained a copy of management agreement dated on 08/02/2023. Regarding the allegation Licensee abandoned the facility, the investigation revealed the following:

It was alleged that the current Licensee Hanh Dao has abandoned the facility. Based on interviews with Hanh Dao, the facility is currently operated by The Hills Administrator Bryant So and Carla Ward as their corporation in the process of applying for their own license.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20240103152625
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 HILLS
FACILITY NUMBER: 306005952
VISIT DATE: 02/23/2024
NARRATIVE
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LPA Mendivil obtained copies of management agreements which stipulates that the perspective licensee must apply for a license. Current Licensee Hanh stated she is in contact with the perspective Licensee monthly and is updated on issues with the facility. Based on interview with Bryant So the corporation The Hills received a letter from the Department on 01/25/2024 stating that the Department has received their application.

Therefore, based on a preponderance of evidence through interviews and records reviewed the allegation that licensee abandoned facility is determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.
No deficiencies cited.

An exit interview was conducted and a copy of this report was provided to facility staff.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2