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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006108
Report Date: 03/20/2024
Date Signed: 03/20/2024 10:50:10 AM


Document Has Been Signed on 03/20/2024 10:50 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:OHANA CARE 3FACILITY NUMBER:
306006108
ADMINISTRATOR:FISK, RYANFACILITY TYPE:
740
ADDRESS:24362 AUGUSTIN STTELEPHONE:
(949) 989-1975
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 0DATE:
03/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ryan Fisk, Administrator (via phone)
Brigitte Fisk, Administrator		TIME COMPLETED:
10:45 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting a required annual visit. LPA called licensee Ryan Fisk who confirmed that the facility was not operating. LPA walked up to the licensed facility and was greeted and granted entry by Brigitte Fisk, Administrator after stating the purpose of the visit.

During the pre-licensing visit conducted on March 28, 2022, facility administrator Ryan Fisk had informed LPA that the facility was no longer receiving residents due to a pending remodel. The remodel is observed to still be under way at this time. LPA accompanied with administrator conducted a walk-through of the physical plant and confirmed that the facility was not currently in operation.

No deficiencies cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
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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