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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306001000
Report Date:
11/22/2022
Date Signed:
11/22/2022 01:43:33 PM
Document Has Been Signed on
11/22/2022 01:43 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 VIEW
FACILITY NUMBER:
306001000
ADMINISTRATOR:
DANIEL LINES
FACILITY TYPE:
740
ADDRESS:
5900 CHAPMAN AVE
TELEPHONE:
(714) 898-3524
CITY:
GARDEN GROVE
STATE:
CA
ZIP CODE:
92845
CAPACITY:
160
CENSUS:
49
DATE:
11/22/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:31 PM
MET WITH:
Melissa Weibel - Executive Director
TIME COMPLETED:
02:00 PM
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On 11/22/2022 Licensing Program Analysts (LPAs) Kevin Saborit-Guash and Alvaro Ramirez along with Executive Director (ED) Melissa Weibel conducted a Case Management visit. LPAs informed ED Weibel that the facility has 30 days to notify Community Care Licensing division when there is a change in Administrator.
On this date Administrator was reminded of the regulation and the reporting requirements when hiring a new Administrator. A Technical Assistance was issued.
An exit interview was conducted and a copy of this report and Technical Advisory was provided prior to leaving the facility.
SUPERVISOR'S NAME:
Alisa Ortiz
TELEPHONE:
(714) 287-4084
LICENSING EVALUATOR NAME:
Kevin Saborit-Guasch
TELEPHONE:
714-703-2851
LICENSING EVALUATOR SIGNATURE:
DATE:
11/22/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/22/2022
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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