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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
300606831
Report Date:
09/30/2020
Date Signed:
09/30/2020 10:45:08 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:
FREEDOM VILLAGE
FACILITY NUMBER:
300606831
ADMINISTRATOR:
MARIANNE CASINO/ J.NIBLETT
FACILITY TYPE:
741
ADDRESS:
23442 EL TORO ROAD
TELEPHONE:
(949) 472-4733
CITY:
LAKE FOREST
STATE:
CA
ZIP CODE:
92630
CAPACITY:
533
CENSUS:
395
DATE:
09/30/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Jennifer Suckiel - Executive Director
TIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Patricia Velazquez
contacted the facility via telephone to conduct a Case Management visit telephonically due to the COVID-19 Pandemic and pre-cautionary measures.
This Case Management televisit to Freedom Village was in conjunction with a complaint investigation visit with control number 22-AS-20200928144157. The purpose of this Case Management visit was to conduct a health and safety evaluation. LPA Velazquez spoke with Executive Director (ED) Jennifer Suckiel.
LPA Velazquez along with ED Suckiel conducted a partial tour of the Independent Living portion of the physical plant utilizing FaceTime virtual technology. Just outside the main entrance LPA and ED observed a few residents sitting on some benches. LPA and ED observed the seating area in the entry of the facility as well as the Bistro where meals can be obtained. There was a check-in table in the entry of the facility. Per ED Suckiel currently there is no in-person dining in the Bistro or in the main dining room of the facility. LPA and ED entered the game room that currently serves as a handwashing station for staff. During the tour of the interior portion of the physical plant LPA and ED observed a resident walking through a hallway. LPA and ED also entered Room East 207 that was occupied by a former resident. Room East 207 consists of 2 bedrooms and 2 bathrooms. LPA and ED also toured the Rose Garden in the exterior of the facility and observed residents putting on the putting green.
There were no deficiencies issued during this Case Management visit. An exit phone interview was conducted with ED Jennifer Suckiel
and a copy of this report was signed by LPA Patricia Velazquez. The report will be sent via email to ED Suckiel who agrees to sign and date the report. This report was sent via email and an electronic read receipt confirms receiving the report. ED Suckiel agrees to send the original report by mail to the CCLD Regional Office (RO) in Orange.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2870
LICENSING EVALUATOR NAME:
Patricia Velazquez
TELEPHONE:
(714) 380-0440
LICENSING EVALUATOR SIGNATURE:
DATE:
09/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/30/2020
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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