<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001706
Report Date: 03/01/2022
Date Signed: 03/01/2022 12:02:24 PM


Document Has Been Signed on 03/01/2022 12:02 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:BEST ELDERLY CARE IFACILITY NUMBER:
306001706
ADMINISTRATOR:MARIANA NITAFACILITY TYPE:
740
ADDRESS:17912 LINCOLN STTELEPHONE:
(714) 639-5885
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY:6CENSUS: 5DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Administrator, Mariana NitaTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility by Staff and temperature was checked upon arrival. LPA Tirre explained the reason for the visit.

During the visit LPA toured the facility with Administrator Mariana Nita. Facility is a 10 bedroom,( 6 resident bedrooms 4 staff bedrooms) and 4 bathrooms two story home. There are 5 Residents in care. LPA observed proper covid signage near front entrance of facility as well as sign in, sanitization and temperature check station. Facility has required Department postings. LPA observed copy of Administrators Certificate expiring August 21,2022. LPA toured all Residents rooms, all rooms where within regulations. All restrooms observed contained soap, toilet paper, and hand towels. Restrooms had proper hand washing signs posted. Residents were observed relaxing in their bedrooms watching TV. Facility has operating smoke detectors, carbon monoxide detector and audible alarms for each sliding door entrance/exit. Facility has 2 fire extinguishers. Facility has supply of PPE. Facility has 5 refrigerators with ample food supply. LPA observed facility has ample emergency food and water supply. Facility has required Emergency Disaster Plan posted. Facility has a secured location for resident medication and files. Facility has 30 days supply of medications for Residents. LPA reviewed 5 of 5 Residents files during visit. Residents emergency contact information and Physicians reports are current. Facility has several designated visitation areas.

No deficiencies noted during todays visit. An exit interview was conducted with Administrator Mariana Nita and a copy of report was left at facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1