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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001232
Report Date: 02/07/2025
Date Signed: 02/07/2025 05:51:34 PM

Document Has Been Signed on 02/07/2025 05:51 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:MEMORY LANE ELDERLY CAREFACILITY NUMBER:
306001232
ADMINISTRATOR/
DIRECTOR:		BORDUZ, FLAVIA & GHEORGHEFACILITY TYPE:
740
ADDRESS:2507 W. KEYS LANETELEPHONE:
(714) 484-6639
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Gheorghe Borduz, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Rose Ruppert and Hanna Gough are conducting this unannounced visit to complete the required annual inspection. LPAs arrived at the facility and were greeted and granted entry by staff. LPAs met with Gheorghe Borduz, Licensee, and explained the nature of the visit.

The Facility is a single story home with six bedrooms with three resident bedrooms, four bathrooms, with two of the bathrooms for residents. The resident quarters also has a living room and a dining room. The licensee resides on the premises and has three bedrooms, a living room, 2 bathrooms, and the kitchen all divided by doors that can lock. The garage is attached with the entrance being inaccessible to residents. The facility currently has no residents. LPAs toured the facility with the licensee. LPAs observed the See Something, Say Something poster along with the ombudsman poster in the main resident hallway. LPAs toured the kitchen and food storage areas. There is a minimum of seven days of non-perishable foods and two days of perishable foods readily available with an emergency food and water supply stored in the garage. There is additional food stored in the garage refrigerator with all temperatures between regulatory degrees. LPAs inspected that medications are centrally stored in a locked cupboard in the resident hallway. LPAs measured the hot water temperature which measured between 107.9 and 108.8 degrees Fahrenheit. All bathrooms were observed to have a supply of soap, toilet paper and paper towels. LPAs observed that toxic chemicals, cleaning solutions and disinfectants are stored in the cabinet under the sink and that it is locked. LPAs observed that the facility has a clean supply of linens.

(Continued on LIC 809-C)

Alisa OrtizTELEPHONE: (714) 287-4084
RoseMarie RuppertTELEPHONE: 714-703-2840
DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MEMORY LANE ELDERLY CARE
FACILITY NUMBER: 306001232
VISIT DATE: 02/07/2025
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 (Continued from LIC 809)

LPAs inspected resident bedrooms which had all the required furnishings and components. Fire and carbon monoxide detectors were tested and found to be operational. LPAs toured the outside of the facility and saw a shaded seating area for resident use. LPAs observed games and activities for resident pleasure.

LPAs observed a fire extinguisher in the kitchen with a purchase date of May 8, 2024. The last fire drill conducted was on May 25, 2024. LPAs gave a technical violation due to no residents at the facility. LPAs reviewed one of one staff file no discrepancies were observed. All staff present had a criminal record clearance and associated to the facility.



This report was reviewed with Licensee Gheorghe Borduz, an exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: RoseMarie RuppertTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC809 (FAS) - (06/04)
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