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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006260
Report Date: 05/08/2024
Date Signed: 05/08/2024 01:02:03 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/08/2024 01:02 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:IRVINE COTTAGE #1FACILITY NUMBER:
306006260
ADMINISTRATOR:WALTERS, KIMBERLYFACILITY TYPE:
740
ADDRESS:1 LONGSTREETTELEPHONE:
(949) 533-5938
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY:6CENSUS: 0DATE:
05/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Kimberly ArnettTIME COMPLETED:
09:19 AM
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Licensing Program Analyst (LPA) Michael Tea and Licensing Program Analyst Manager (LPM) Sheila Santos conducted an unannounced annual inspection. Upon arrival no one was home, LPA contacted Administrator Kimberly Arnett and was informed that facilities not operating at this time. There were no clients observed and construction and remodeling was notice inside the facility. Spoke to Admin. Arnett that the facility is going under remodeling and per administrator that an email was sent to licensing to notify about the on-going construction.

This report was reviewed with the Administrator and a copy of this report was provided to the facility at the time of exit interview for the annual inspection for Irvine Cottage #2 facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael TeaTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024
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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