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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006569
Report Date: 10/23/2024
Date Signed: 10/23/2024 08:44:21 AM

Document Has Been Signed on 10/23/2024 08:44 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NICO BRIGHT HORIZONS CARE HOME - DONNA LANEFACILITY NUMBER:
306006569
ADMINISTRATOR/
DIRECTOR:		MENDOZA, CATHERINEFACILITY TYPE:
735
ADDRESS:11771 DONNA LANETELEPHONE:
(213) 400-3389
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 6CENSUS: 0DATE:
10/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Pearl UyTIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) Lydia Martinez conducted this announced continuation of the Pre-licensing visit to ensure the facility made the necessary corrections required from the Pre-licensing visit inspection on 10/17/2024. LPA Martinez met with prospective House Manager Pearl Uy and both toured the facility.

On 10/17/2024, LPA noted Fire Clearance did not match the structure as it had been previously approved by Fire inspector on 6/17/2024 (i.e. door going from garage to enclosed patio and a barnlike door) were not marked on the floor plan.

A new Fire Clearance was approved on 10/21/2024.

The items identified for correction during initial Pre-licensing visit of 10/17/2024 are now corrected. With the above corrections completed the facility's physical plant meets requirements of Title 22 Regulations.

All items reviewed during the visit are in compliance. Facility appears to be ready for licensure based on LPA's evaluation. An exit interview was conducted with Pearl and a copy of this report was sent to email on file.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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