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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000889
Report Date: 10/28/2020
Date Signed: 10/28/2020 03:57:14 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:SENIOR LIVING COMMUNITY FOR THE EASTERN STAR IN CAFACILITY NUMBER:
306000889
ADMINISTRATOR:JO DEE GIBSONFACILITY TYPE:
741
ADDRESS:16850 E. BASTANCHURY ROADTELEPHONE:
(714) 577-9281
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:76CENSUS: 39DATE:
10/28/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Brandi McGinnis, Assistant AdministratorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA), Kathrina Chin contacted the facility via telephone for a case management follow up due to COVID-19 and for pre-cautionary measures. LPA Chin identified herself and spoke to Brandi McGinnis, Assistant Administrator and explained the purpose of the call.

This is a follow up on an Exemption Denial of staff 1(S1). LPA Chin informed Brandi McGinnis, Assistant Administrator that S1 exemption request had not been approved and as result, S1 is not cleared to work at the facility.

Ms. McGinnis verified that staff #1 was never hired and is not working at the facility. Ms. McGinnis verified that staff #1 is not in the facility premises.

An exit teleconference was conducted with Brandi McGinnis, Assistant Administrator. A copy of this report will be provided via email. Brandi McGinnis agreed to confirm the receipt of the document, review the report and return a signed copy.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020
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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