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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605516
Report Date: 07/31/2025
Date Signed: 07/31/2025 01:21:50 PM

Document Has Been Signed on 07/31/2025 01:21 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:BUENA PARK SENIOR DAY CARE CENTERFACILITY NUMBER:
300605516
ADMINISTRATOR/
DIRECTOR:		PAT STEWARTFACILITY TYPE:
775
ADDRESS:8150 KNOTT AVENUETELEPHONE:
(714) 826-3163
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 20CENSUS: 11DATE:
07/31/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Jimena TatumTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year annual inspection. LPA Haley entered the Senior Day program and was greeted by Program Manager Jimena Tatum and explained the reason for the visit.

This Senior Day Program is for elderly adults ages 60 years old and above. The program operates Monday through Friday, with operating hours of 8:30AM - 4:00PM. The current capacity of the program is 20. There were 11 participants present during the visit, participating in a variety of activities during the visit. The structure of the day program is a one level classroom/activity area setting with a kitchen area right outside the large classroom/activity area. There is a patio area outside of the building equipped with tables and chairs.

During the inspection, LPA Haley observed a screening station at the entrance of the facility equipped with a temperature thermometer, hand sanitizer, and an attendance sheet. Several cabinets of supplies for the program were present on the outer edges of the main activity room. Each cabinet contains differ items: Emergency disaster kit with various supplies, first aid kits, arts and crafts supplies, emergency flashlights, and plastic eating utensils. Staff and participant files are locked in a cabinet behind the program manager's desk. A fully charged fire extinguisher was observed mounted on the wall near the exit door that leads to the kitchen area.

The kitchen area contains a refrigerator, sink and appliances like a toaster, coffee maker and microwave. Sharps are locked in a drawer near the sink. Cleaning chemicals are locked under the sink. A supply of towels, a few snacks, an extra water supply, and a cabinet with coffee, and tea was observed.

Continued on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jerome Haley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: BUENA PARK SENIOR DAY CARE CENTER
FACILITY NUMBER: 300605516
VISIT DATE: 07/31/2025
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The program shares restrooms with the senior center. The restroom were clean, organized, and stocked with had soap and paper towels.

The last fire drill was held June 27, 2025, and are conducted monthly. The program has smoke detectors and a sprinkler system that’s inspected by public works and coordinated through the Buena Park Senior Center. According to staff in the Senior Center the fire and sprinkler system is inspected annual. The most recent inspection was conducted July 30, 2025.

There were no bodies of water observed.

The day program is current on licensing fees. Two staff interviews were conducted, and two participant interviews were conducted. Two staff files were reviewed and five participant files were reviewed. The program manager provided a new back up telephone number: 951.312.3311 and a new program email address: jtatum@mealsonwheelsoc.org.

No deficiencies are being cited during today’s visit. An exit interview conducted, and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jerome Haley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC809 (FAS) - (06/04)
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