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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006128
Report Date: 05/05/2022
Date Signed: 05/05/2022 11:10:42 AM


Document Has Been Signed on 05/05/2022 11:10 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:VILLAS BY DOCTOR ROYAFACILITY NUMBER:
306006128
ADMINISTRATOR:JAFARI-HASSAD, ROYAFACILITY TYPE:
740
ADDRESS:23232 LA VACA STTELEPHONE:
(516) 322-3095
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 0DATE:
05/05/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Roya Jafari-HassadTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an announced continued prelicensing visit today to ensure the facility has made the correction required from the 03/30/2022 visit. LPA arrived at facility at 9:30am there was no answer. Applicant arrived shortly after and met with LPA.

During the visit the LPA verified the following is corrected:

1. The water heater needs to be in working condition to deliver hot water.



LPA measured the hot water, temperature measures 105.8 Fahrenheit degrees in residents' restrooms.

The LPA observes that the item identified for correction during initial prelicensing visit of 03/30/2022 is now corrected.

Facility appears to be ready for licensure. Accordingly, LPA will submit file for approval to CCL Supervisor.



Exit interview was conducted with applicant and a copy of this report was left with the applicant.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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