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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002482
Report Date: 06/20/2024
Date Signed: 06/20/2024 12:06:52 PM


Document Has Been Signed on 06/20/2024 12:06 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:CAREWELL MANORFACILITY NUMBER:
306002482
ADMINISTRATOR:CAROL WILSONFACILITY TYPE:
740
ADDRESS:3330 W. STONYBROOK DRIVETELEPHONE:
(714) 827-8520
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 2DATE:
06/20/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Carol Wilson, Administrator (via telephone)TIME COMPLETED:
12:10 PM
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On this day, Licensing Program Analyst (LPA) conducted a review of the plan of corrections for a deficiency cited on April 29, 2024 regarding the presence of a bedridden resident in a facility for which the current fire clearance did not include a provision for the admission of bedridden individuals.

The bedridden resident R1 has since passed away. However no death reports have been submitted to the Department at this time. However, the facility is no longer in violation of Section 87606(c) of the California Code of Regulations regarding the Care of Bedridden Residents, therefore the type A deficiency issued on April 29, 2024 is cleared at this time.

A Technical Violation Advisory Note on reporting requirements is however issued to the licensee, as well as a consultation provided in order to ensure the timely reporting of Unusual Incidents directly to the Regional Office.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
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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