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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006472
Report Date: 02/21/2025
Date Signed: 02/21/2025 01:35:38 PM

Document Has Been Signed on 02/21/2025 01:35 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:SAN CLEMENTE VILLAS BY THE SEAFACILITY NUMBER:
306006472
ADMINISTRATOR/
DIRECTOR:		PAOLI, FREDFACILITY TYPE:
740
ADDRESS:660 CAMINO DE LOS MARESTELEPHONE:
(949) 489-3400
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92673
CAPACITY: 190CENSUS: 90DATE:
02/21/2025
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Business Office Manager Sharon GerkenTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On today’s date Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced collateral visit while conducting initial visit into investigation Control Number 22-AS-20250220115306. LPA met with Business Office Manager Sharon Gerken and explained reason for visit.

During today’s visit, LPA Tirre toured facility and collected pertinent documents such as facility staff roster, resident roster and Resident 1 record file.

Exit interview conducted with Business Office Manager Sharon Gerken and copy of report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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