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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006580
Report Date: 09/25/2024
Date Signed: 09/25/2024 07:14:33 AM


Document Has Been Signed on 09/25/2024 07:14 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:CARE ACHILLESFACILITY NUMBER:
306006580
ADMINISTRATOR:GABRIEL, JEHLA ROSEFACILITY TYPE:
740
ADDRESS:598 PIERPONT DRTELEPHONE:
(424) 270-4452
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: 0DATE:
09/25/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:00 AM
MET WITH:Jehla Rose Gabriel- ApplicantTIME COMPLETED:
07:35 AM
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Licensing Program Analyst (LPA) Jessica Cho conducted an announced subsequent Pre-Licensing visit to follow-up on the issues that were present during the initial visit on September 19, 2024. LPA Cho met with Applicant Jehla Rose Gabriel to follow up on the following corrections:
  • Regarding liability coverage, it is pending approval upon licensure per notice dated September 23, 2024. Applicant will submit proof of coverage upon receipt to LPA via email.
  • Stair flooring leading to the loft on the second floor (which was part of the initial plan of the applicant) was replaced.

On today's visit the aforementioned item have been addressed and corrected. The item reviewed during this visit are in compliance. The Pre-Licensing is now complete. The licensee will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau.

Component III is waived due to the applicant operating another Residential Care for the Elderly (RCFE) licensed facility and having completed Component III. This concludes the Pre-Licensing inspection.

An exit interview was conducted with Applicant Jehla Rose Gabriel, and a copy of this report was provided at the end of the visit.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
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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