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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600816
Report Date: 07/20/2021
Date Signed: 07/20/2021 12:12:16 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: 175DATE:
07/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Kerri Clark, Director of Operations TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA), Kathrina Chin and Vicki Smith, Program Administrator and Kimberly Lewis, Assistant Program Administrator made an unannounced case management-incident visit at this Continuing Care Retirement Community and met with Kerri Clark, Director of Operations. Ms. Clark provided a tour of the CCRC campus such as the Independent Living, Assisted Living and Memory Care.

During the visit, facility staff was observed to follow the mitigation plan and has sufficient PPE supplies.


No deficiency observed this review as per Title 22 of the California Code of Regulations.

An exit interview was conducted and a copy of this report was provided to Kerri Clark, Director of Operations.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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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