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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001939
Report Date: 10/19/2021
Date Signed: 10/19/2021 02:49:28 PM

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:A.C.E. ADVANCED CARE FOR ELDERLYFACILITY NUMBER:
306001939
ADMINISTRATOR:GEORGETA FIRUTAFACILITY TYPE:
740
ADDRESS:2400 TRYON AVE.TELEPHONE:
(714) 926-4902
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY:6CENSUS: 3DATE:
10/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Georgeta ArdeleanuTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Norman Woodridge conducted a Covid-19 Annual Inspection at the facility. Upon arrival, LPA informed Staff 1 (S1) of the purpose of the visit and was granted entry into the building. LPA and S1 conducted a tour of the inside and outside of the facility, common areas, resident rooms, restrooms, garage, and kitchen.

LPA discussed and observed the following:

There were 2 staff and 3 residents present at the facility. Residents rooms were clean and organized. LPA observed 2-day supply of perishables, 7-day supply of non-perishables, and stored PPE. Hallways and walkways were free from obstruction and LPA observed medication and cleaning supplies that were locked up. LPA discussed updated Covid-19 requirements with Administrator, Georgeta Firuta, and reviewed Covid-19 records for residents. LPA also reviewed Covid-19 sign in sheet for visitors. LPA discussed PIN 21-40 ASC: Updated Statewide Visitation, Waiver, and Testing and Vaccination Verification Guidance for Visitors Related to Coronavirus Disease 2019 (Covid-19). LPA provided technical assistance regarding Covid-19 related signage.

No deficiencies were noted during the inspection.

An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Norman WoodridgeTELEPHONE: (714) 703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
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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