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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600816
Report Date: 09/10/2020
Date Signed: 09/11/2020 04:11:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ROWNTREE GARDENSFACILITY NUMBER:
300600816
ADMINISTRATOR:CLAUDIA LUSCA-BORCSAFACILITY TYPE:
741
ADDRESS:12151 DALE STREETTELEPHONE:
(714) 530-9100
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:280CENSUS: 174DATE:
09/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Claudia Lusca, Executive DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Kathrina Chin made an unannounced virtual tele visit to the facility for the purpose to review a confirmation of an employee Conditional Exemption Approval.

LPA Chin discussed and reviewed the exemption approval conditions with Executive Director, Claudia Lusca regarding staff 1 as stated below:

This exemption is approved with the following conditions:
1. Does not transport clients.
2. The individual does not violate any licensing laws or regulations.
3. The individual does not engage in conduct that indicates that he/she may pose a risk to the health and safety of any individual who is or may be a client.
4. The individual does not fail to disclose a conviction even if it occurred before the exemption was granted.
5. The individual is not convicted of a subsequent crime.

Ms. Lusca confirms that the facility is acting in accordance with the approval exemption's conditions. Ms. Lusca affirms that a copy of the Conditional Exemption Approval letter has been placed in the respective employee's file.

An exit phone interview was conducted with Claudia Lusca, E.D. and a copy of this report will be sent via email to Claudia Lusca, E.D. who agrees to sign the report and return via email.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020
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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