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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001000
Report Date: 05/07/2024
Date Signed: 05/07/2024 02:15:57 PM


Document Has Been Signed on 05/07/2024 02:15 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:BROOKDALE VALLEY VIEWFACILITY NUMBER:
306001000
ADMINISTRATOR:PATRICIA PEREZFACILITY TYPE:
740
ADDRESS:5900 CHAPMAN AVETELEPHONE:
(714) 898-3524
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY:160CENSUS: 46DATE:
05/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Patricia PerezTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on incident reports submitted to the department. LPA was greeted and granted entry into the facility and explained the reason for the visit.

Incident report dated 04/22/2024 indicated Resident 1 (R1) reported missing checks from the resident room. The theft was of two checks in the amount of $900 each. Two days later Resident 2 (R2) reported $140 in cash missing from room. On 04/28/2024, Resident 3 (R3) reported missing checks in the amount of $1000 and Resident 4 (R4) reported $1000 cash missing on 04/29/2024. Facility conducted an investigation on 04/22/2024 and Staff 1 admitted to the thefts and was terminated. Garden Grove Police responded to the incident and charges are pending. It was determined through investigation that S1 attempted to cash $6,260 through a check cashing business. LPA interviewed the theft victims during the visit and all confirmed the thefts. All residents with checks missing were reimbursed through individual banks.




Exit interview 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: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024
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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