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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600816
Report Date: 09/24/2024
Date Signed: 09/24/2024 05:07:55 PM


Document Has Been Signed on 09/24/2024 05:07 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:ROWNTREE GARDENSFACILITY NUMBER:
300600816
ADMINISTRATOR:CLAUDIA LUSCA-BORCSAFACILITY TYPE:
741
ADDRESS:12151 DALE STREETTELEPHONE:
(714) 530-9100
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:280CENSUS: 182DATE:
09/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Claudia Lusca TIME COMPLETED:
03:09 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. Administrator (AD) Claudia Lusca was called and arrived at the reception desk, was present during the visit and lead the tour of the facility.

The inspection began by inspecting random rooms in the Memory Care unit, Independent Living, and Assisted living. Random rooms were inspected while residents were having lunch. All resident rooms that were inspected were clean, well organized, and had all the necessary requirements: night stand, chair, lamps/lights and storage space.

In the resident bathrooms, all grab bars were tightly secured to the wall. No hazardous items were observed in any of the resident bathrooms. Bathroom water temperatures were recorded in the range of 105.8 - 107 degrees Fahrenheit.

The kitchen was clean and well organized. LPA Haley observed temperature logs on all the refrigerators, and a temperature logbook for all the cooked food. The facility has a two-day supply of perishable food items and seven-day supply of nonperishable food items. All canned food noted to be within expiration date.

The exterior portion of the facility was clean, and well organized. LPA Haley observed plenty of shaded areas with tables and chairs. Walkways were clean, clear, and free of debris and tripping hazards. No bodies of water was observed.

The facility conducts various emergency evacuation drills, the last evacuation drill was conducted August 23, 2024. Disaster drills are conducted quarterly, and the last fire drill was conducted July 29, 2024.

Continued on LIC809C

SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
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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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: ROWNTREE GARDENS
FACILITY NUMBER: 300600816
VISIT DATE: 09/24/2024
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During the inspection LPA Haley observed several fire extinguishers mounted on the walls in various places, and a few fire hoses were also observed.

Tri Signal Integration INC conducts a quarterly Fire Alarm Life Safety System Inspection. The last inspection was conducted April 16, 2024.

During the inspection, 9 staff files were reviewed, 5 resident files were reviewed, 5 resident medications were reviewed, and 3 resident interviews were conducted.

No deficiencies are being cited during todays visit. An exit interview was conducted, and a copy of the report was provided to Administrator Claudia Lusca.

SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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