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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600977
Report Date: 08/12/2021
Date Signed: 08/12/2021 10:38:04 AM

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:TOWN & COUNTRYFACILITY NUMBER:
300600977
ADMINISTRATOR:STEPHENIE JUKICFACILITY TYPE:
741
ADDRESS:555 E. MEMORY LANETELEPHONE:
(714) 547-7581
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:328CENSUS: 137DATE:
08/12/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:29 AM
MET WITH:Stephanie JukicTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Kimberly Lyman made an announced case management visit to the facility. LPA was greeted and granted entry into the facility by Administrator Stephanie Jukic.

The purpose of the visit was to observe the new memory care building.

At 9:45 AM, LPA toured the building with Director of Residential Services Stephanie Jukic, Director of Health and Wellness Heather Lopez, Director of Marketing Lindsay Troge and Director of Facilities Jimmy Troge. New building contains four neighborhoods with ten semi-private rooms and two private rooms with a total bed count of 88. The building consists of two stories, a patio on each floor, and ample activity and visitation areas. Each floor contains a kitchen and dining area.

Licensee to post the "Let Us Know" poster in entrance of facility.

No health and safety violations noted during today's visit and facility is approved to accept residents per fire clearance granted on 07/02/2021.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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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