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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006248
Report Date: 01/30/2025
Date Signed: 01/30/2025 12:45:13 PM

Document Has Been Signed on 01/30/2025 12:45 PM - 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:MORNINGSTAR SENIOR LIVING OF MISSION VIEJOFACILITY NUMBER:
306006248
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, GEORGEFACILITY TYPE:
740
ADDRESS:28570 MARGUERITE PARKWAYTELEPHONE:
(949) 649-4855
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY: 198CENSUS: 99DATE:
01/30/2025
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:George GonzalezTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Kimberly Lyman and Fred Arias conducted an unannounced collateral visit regarding a complaint filed at another licensed facility. LPAs were greeted and granted entry into the facility and explained the reason for the visit.

During the visit, LPAs toured the facility and interviewed Resident 1 (R1) as well as reviewed and obtained pertinent documentation such as physician report and pre-appraisal.










Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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