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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300602548
Report Date: 09/06/2023
Date Signed: 09/06/2023 05:37:14 PM


Document Has Been Signed on 09/06/2023 05:37 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:KATELLA SENIOR LIVING COMMUNITYFACILITY NUMBER:
300602548
ADMINISTRATOR:CHRISTINE GREENWAYFACILITY TYPE:
740
ADDRESS:3952 KATELLA AVENUETELEPHONE:
(562) 596-2773
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY:140CENSUS: 57DATE:
09/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:01 PM
MET WITH:Christine GreenwayTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced case management visit to address the issues observed during a required 10-day complaint visit (complaint # 22-AS-20230829113742). LPA observed there was no See Something, Say Something sign (PUB 475) posted in the entrance way of the facility. LPA informed the Executive Director who reported the correct sign would be posted. A Technical Assistance Advisory Note was issued. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023
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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