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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006263
Report Date: 03/20/2024
Date Signed: 03/20/2024 12:45:52 PM


COMPREHENSIVE INSPECTION

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



FACILITY NAME:GRANNY'S PLACE #6FACILITY NUMBER:
306006263
ADMINISTRATOR:NESBITT, MICHELLEFACILITY TYPE:
740
ADDRESS:26722 PEPITATELEPHONE:
(949) 533-5938
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 0DATE:
03/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Tammie Sampedro, Executive Administrator
Jozef Spinger, Assistant Administrator		TIME COMPLETED:
01:00 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 the required annual inspection visit. LPA rang the bell with no response. LPA later called Executive Administrator Tammie Sampedro who confirmed that this licensed location was not operational at this time as a result of ongoing construction.

Executive Administrator and Assistant Administrator arrived later at the licensed location to assist with the visit. LPA was greeted and granted entry upon arrival.

The location is confirmed by a tour of the physical plant to not be under operation at this time. Licensee is instructed to notify the Department before resuming operations.

No deficiencies are noted per Title 22 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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