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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001000
Report Date: 08/16/2024
Date Signed: 08/16/2024 02:42:18 PM


Document Has Been Signed on 08/16/2024 02:42 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
ORANGE COUNTY RO, 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: 55DATE:
08/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Patricia Perez, Executive DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Rose Ruppert conducted an unannounced case management visit at 1:30 PM. LPA was greeted and granted entry into the facility by concierge and met with Patricia Perez, Executive Director.

The purpose of the visit is to follow-up on an eviction letter received in our office on May 6, 2024 for Resident #1 (R1). LPA requested resident records from Business Office Coordinator and was informed that R1 had passed away on May 30, 2024. LPA obtained a copy of the death report for R1.

An exit interview was conducted with Patricia Perez, ED and a copy of the report and files reviewed (LIC 858) were given at the time of the visit.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: RoseMarie RuppertTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2024
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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