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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613239
Report Date: 09/14/2021
Date Signed: 09/14/2021 03:11:15 PM

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:ACCENT ON SENIORSFACILITY NUMBER:
300613239
ADMINISTRATOR:SHARON WILLIAMSFACILITY TYPE:
740
ADDRESS:273 VIA BALLENATELEPHONE:
(949) 361-2093
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY:6CENSUS: 5DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Corazon Alano and Sharon WilliamsTIME COMPLETED:
02:36 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver Corazon Alano and explained the reason for the visit. Caregiver Kathryn Alano was present as well. Administrator Sharon Williams arrived during the visit. Administrator Sharon Williams has an administrator certificate expiring on 01/31/2022.
At 12:50 PM, LPA toured the facility with Caregiver Kathryn Alano. Facility has five residents in care during today's visit, with one on hospice care. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms are single occupancy and had the required elements as well as restrooms stocked with soap/ sanitizer. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the entrance of the facility. Facility utilizes a visitor sign in sheet. Facility takes resident/ staff temperatures daily and documents. Facility has covid precaution postings as well as all required department postings. LPA observed the first aid kit has all required items. Facility mitigation plan has been approved. LPA observed an ample supply of emergency food and water. LPA observed a generator on-site. LPA toured the outside grounds and observed multiple shaded outside visitation areas. Exit gates are unlocked and self latching. LPA observed the locked medication storage area. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed five resident files during the visit and all files are up to date including emergency information. All residents and staff are vaccinated for Covid-19.
During the visit, LPA consulted with Caregiver and Administrator regarding oversight of caregiver's child on-site at the facility.
No deficiencies noted during today's visit. An exit interview was 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: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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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