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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850077
Report Date: 02/08/2022
Date Signed: 02/08/2022 02:21:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:OCEAN BREEZE AT BRADFORDFACILITY NUMBER:
565850077
ADMINISTRATOR:RAYAS, EVELYNFACILITY TYPE:
740
ADDRESS:17 BRADFORD AVETELEPHONE:
(714) 595-1286
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 0DATE:
02/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Dania FayyadTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Kelly Dulek conducted a case management - other visit with the purpose of following up with the Licensee following the request to close the facility emailed to the LPA on 02/02/2022. LPA arrived at the facility at 01:04 PM and met with Licensee Dania Fayyad. Entrance interview conducted.

LPA and Licensee toured the facility at 1:55 PM, both indoor and outdoor and all facility grounds. LPA did not observe any residents or personal belongings in the home at the time of the visit. Some facility-owned couches, furniture, and furnishings remain in the facility, but the Administrator was observed moving items out at the time of the visit. Licensee stated the facility will be utilized as a residential rental going forward.

The Licensee advised that the last resident moved out on Monday January 31, 2022 and that they have not had any new residents after the last resident relocated. LPA had previously discussed the potential closure with the Licensee in December 2021. Based on the LPA's observations during today's visit the LPA concluded that all operation of the Residential Care Facility for the Elderly has ceased. The Licensee surrendered the License to the LPA during today's visit.

Exit interview conducted. A copy of the report was provided via email.
SUPERVISOR'S NAME: TELEPHONE:
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
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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