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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306000347
Report Date:
05/03/2022
Date Signed:
05/03/2022 10:25:34 AM
Document Has Been Signed on
05/03/2022 10:25 AM
- 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:
ATRIA SAN JUAN
FACILITY NUMBER:
306000347
ADMINISTRATOR:
JAMES CRADDOCK
FACILITY TYPE:
740
ADDRESS:
32353 SAN JUAN CREEK RD
TELEPHONE:
(949) 661-1220
CITY:
SAN JUAN CAPISTANO
STATE:
CA
ZIP CODE:
92675
CAPACITY:
140
CENSUS:
100
DATE:
05/03/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
08:30 AM
MET WITH:
James Craddock
TIME COMPLETED:
10:35 AM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA met with executive director Jim Craddock. LPA explained the reason for the visit. LPA and executive director toured the facility. LPA observed Covid-19 precautionary signs throughout the facility. LPA observed the Ombudsman poster and the See Something Say Something poster (PUB 475). LPA observed the fireplace in the living room/library is screened. LPA observed all staff wearing masks. All fire extinguishers are fully charged. The medication carts are kept locked and secured in the wellness center. LPA observed all stairwells had emergency chair lifts. LPA and executive director toured the kitchen and dining room. The kitchen and dining room are clean and organized. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. LPA observed resident rooms are spacious and contain the required furnishings. LPA and executive director toured the memory care unit. No obstacles or hazards observed in the memory care unit. Facility conducts emergency drills monthly with the staff. LPA observed a raised fountain in the central courtyard. Facility has a mitigation plan that has been approved. No obstacles or hazards observed inside or outside of the facility. No deficiencies observed. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
05/03/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/03/2022
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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