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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006574
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:45:20 PM

Document Has Been Signed on 02/20/2025 03:45 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:NENE'S BAHAYFACILITY NUMBER:
306006574
ADMINISTRATOR/
DIRECTOR:		ALMACEN, VOLTAIREFACILITY TYPE:
735
ADDRESS:29361 SAN BRISO PL.TELEPHONE:
(949) 288-3355
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 4CENSUS: 0DATE:
02/20/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Voltaire Almacen, Delwyn LacsonTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to the facility to conduct the pre-licensing inspection. LPA met with applicants Voltaire Almacen and Delwyn Lacson An initial application to operate an Adult Residential Facility (ARF) was submitted to CCL on May 6, 2024. The facility is to have a capacity of 4 ambulatory residents. This is a new facility with no clients in care. The facility phone number is 949-503-1550

Structure:
The facility is a two story house with 7 bedrooms, 4 bedrooms are for clients, 3 bathrooms, living room, dining room, kitchen and an attached 2 car garage. LPA observed night lights mounted in the hallways. There is a backyard with no bodies of water. There is a shaded seating area with tables and chairs outside.
Air/Heating:
Central air/heating system installed with a central panel on the wall to control the temperature.

Resident Bedrooms:
There are 4 client bedrooms. The bedrooms are spacious and will easily accommodate the clients' belongings. All client rooms had the required furnishings and linens.

Medications, First-Aid Kit & Book:
Medication is kept locked in the laundry. The first aid kit and the first aid manual are stored in the kitchen pantry. Knives and sharp objects are kept locked in a kitchen drawer.

Bathrooms:
All bathrooms have working showers and toilets. All bathrooms are clean and operational.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NENE'S BAHAY
FACILITY NUMBER: 306006574
VISIT DATE: 02/20/2025
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Water Temperature:
Hot water was measured in both bathrooms. Hot water measured 107.2 degrees Fahrenheit in all bathrooms.

Linens & Hygiene Supplies:
Adequate supply of linens and toiletries stored in hall closet.

Emergency Phone Numbers, Exit Plan & Menu:
Posted & readily available for review. The emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food served for one week. LPA observed the PUB 475 poster posted in the main entry way.

Food Service:
LPA observed a 3 day supply of emergency food and water in the garage. No clients are currently residing in the facility.

Smoke Detectors/Carbon Monoxide Detectors:
Smoke detectors/carbon monoxide detectors tested operational. Both (2) Fire Extinguishers are fully charged and mounted on the wall in the hallway.

Appliances:
LPA observed a 5 burner gas stove, microwave oven, refrigerator and dishwasher. The washer and dryer are in the laundry room. All appliances are clean and operational, except the gas stove.

Toxins:
The cleaning supplies are kept locked in the laundry room.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NENE'S BAHAY
FACILITY NUMBER: 306006574
VISIT DATE: 02/20/2025
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Client & Staff Files:
The Client and Staff Records will be kept locked in a file cabinet in the dining room.

Reading Material, Games, Equipment & Materials:
Games, reading material and puzzles are stored in the living room. There is a large screen TV mounted on the wall in the living room. There is no fireplace in the facility.

Fire clearance:
Fire Clearance was approved by Orange County Fire Authority on May 21, 2024.

Component III:
Component three waived applicants, own and operate another licensed facility.

Facility ready to be licensed.

Applicant was informed today that the final approval will be processed by CAB (Cental Application Bureau) in Sacramento.

Exit interview was conducted and a copy of this report was left with the applicant.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
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