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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006128
Report Date: 04/28/2023
Date Signed: 07/07/2023 09:29:55 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/07/2023 09:29 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:
04/28/2023
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Realtor-Kacper Turek TIME COMPLETED:
11:08 AM
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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility to conduct the required annual inspection. Upon arrival at 9:56am the Administrator (AD) Roya Jafari-Hassad was not available. AD Roya provided consent for realtor Kacper Turek to grant LPA De Perio entry to the facility.

LPA De Perio conducted a tour with realtor Kacper Turek of the interior and exterior physical plant of the facility and observed no residents nor staff present. LPA De Perio toured all bedrooms and observed no personal belongings in any of the bedrooms.

LPA De Perio observed that the facility had no 2-day perishable food supplies, however the facility was observed to have seven-day nonperishable food supplies. Based on today’s observation the facility is not operating.

AD Roya informed LPA De Perio she is in the process of changing ownership.

An exit interview was conducted, and a copy of the report was explained and provide via phone call and email.

LPA De Perio concluded the visit at 11:08am.

Signature on file.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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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