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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006047
Report Date: 12/29/2021
Date Signed: 12/29/2021 10:47:33 AM

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:KNOTT'S LANDING LUXURY CAREFACILITY NUMBER:
306006047
ADMINISTRATOR:RAJPOOT, FAISALFACILITY TYPE:
740
ADDRESS:6359 ARNOLD WAYTELEPHONE:
(949) 290-1826
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:6CENSUS: DATE:
12/29/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Faisal Rajpoot and Kamil RajpootTIME COMPLETED:
11:01 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 Analyst (LPA) Kimberly Lyman made an announced visit to follow up on a pre-licensing visit conducted on 12/07/2021. LPA identified herself and discussed the purpose of the visit with Administrator/ Licensee Faisal Rajpoot. Facility Manager Kamil Rajpoot was present as well.

At 10:10 AM, LPA toured the facility with Licensee and Facility Manager and observed the following:
  • All wood and debris have been removed from backyard and side yard.
  • Facility has a thirty day supply of PPE.
  • Closet door in bedroom has been repaired.
  • Facility has posted the "Let Us No" poster regulation size.
  • Facility water temperature tested between 116.9 and 119.1.










All noted items are in compliance and facility is ready to be licensed.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021
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