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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000147
Report Date: 02/23/2023
Date Signed: 02/23/2023 02:23:10 PM

Document Has Been Signed on 02/23/2023 02:23 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:MT OF OLIVES ADULT DAY CARE CENTERFACILITY NUMBER:
306000147
ADMINISTRATOR:GAYE SATTERFIELDFACILITY TYPE:
775
ADDRESS:24772 CHRISANTA DRIVETELEPHONE:
(949) 581-3800
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 40CENSUS: 26DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Gaye SatterfieldTIME COMPLETED:
02:35 PM
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting an Annual Inspection. LPA met with Administrator (AD) Gaye Satterfield and discussed the purpose of the inspection. LPA and AD conducted a tour of the inside and outside of the facility, common areas, group rooms, kitchen, and storage areas and observed the following:

During the inspection, LPA observed there were 7 staff present, wearing PPE. LPA observed 26 clients were present. LPA confirmed all clients were doing well and observed no health and safety issues. LPA inspected common areas, group rooms, kitchen, and storage areas and observed they were clean and organized, and found no health and safety issues. LPA observed hallways and walkways were free of obstruction.

LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, staffing, infection control/lead/training, PPE, staffing and staffing shortages, and communication and emergency plan. LPA requested and reviewed the resident roster, staff roster, COVID-19 Mitigation Plan, Infection Control Plan, and Emergency Disaster Plan. LPA provided technical assistance regarding storage and N95 Fit Testing.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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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