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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001706
Report Date: 09/12/2022
Date Signed: 09/12/2022 03:46:50 PM


Document Has Been Signed on 09/12/2022 03:46 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: 6DATE:
09/12/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:28 PM
MET WITH:Mariana Nita- Licensee/ Administrator TIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs) Andrea Mendivil and Alvaro Ramirez conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPAs were greeted and granted entry into the facility by Administrator Mariana Nita and explained the reason for the visit.

At 2:30 PM, LPAs toured the facility with Administrator Mariana Nita. Facility is 6 resident bedrooms, 3.5 resident bathrooms, 3 staff bedroom and 1 staff bathroom, two story home with an attached garage. Facility has 6 residents present during today's visit. LPAs observed a screening and sanitizing station at entrance of the facility. LPAs observed residents relaxing in their respective rooms. Facility appears clean and sanitary. All resident rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and paper towels and have hand washing postings. Facility has 5 refrigerators with ample food supply. LPAs observed facility has emergency food and water supply. Facility has a secured location for resident medication and files. LPAs toured the outside grounds and observed outside visitation area. Exit gates are unlocked and self latching. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. LPAs observed a 4 weeks supply of PPE. LPAs reviewed all residents’ files and all contained required documentation including updated emergency information.

No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022
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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