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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306001000
Report Date:
01/15/2025
Date Signed:
01/15/2025 11:15:55 AM
Document Has Been Signed on
01/15/2025 11:15 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:
BROOKDALE VALLEY VIEW
FACILITY NUMBER:
306001000
ADMINISTRATOR/
DIRECTOR:
PATRICIA PEREZ
FACILITY TYPE:
740
ADDRESS:
5900 CHAPMAN AVE
TELEPHONE:
(714) 898-3524
CITY:
GARDEN GROVE
STATE:
CA
ZIP CODE:
92845
CAPACITY:
160
CENSUS:
60
DATE:
01/15/2025
TYPE OF VISIT:
POC
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:
Chiquita Morris
TIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced plan of correction visit to follow up on citations issued on 01/08/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit.
*Deficiency cited under Title 22 Regulation 87464(f)(4) pertaining to Basic Services has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC.
*Deficiency cited under Title 22 Regulation 87628(a) pertaining to Diabetes has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC.
Exit interview conducted and a copy of this report was left at the facility along with clearance letter for cited items.
SUPERVISORS NAME
:
Alisa Ortiz
LICENSING EVALUATOR NAME
:
Kimberly Lyman
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/15/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/15/2025
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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