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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002482
Report Date: 12/03/2024
Date Signed: 12/03/2024 03:33:06 PM

Document Has Been Signed on 12/03/2024 03:33 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CAREWELL MANORFACILITY NUMBER:
306002482
ADMINISTRATOR/
DIRECTOR:
CAROL WILSONFACILITY TYPE:
740
ADDRESS:3330 W. STONYBROOK DRIVETELEPHONE:
(714) 827-8520
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Carol Wilson - AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 12/3/2024 LPAs Dwayne Mason Jr. and Fred Arias arrived at the facility for the purpose of conducting a Plan of Corrections visit. LPAs were greeted and granted entry by facility staff. LPAs met with Administrator Carol Wilson.

On 11/26/2024, the facility received two Type A deficiencies. One deficiency was for toxins that were accessible to residents in two places. The other deficiency was issued due to the absence a medication administration record for PRN medications.

While at the facility, LPAs observed bleach had been moved from two locations accessible residents to the locked garage.

While at the facility, AD provided LPAs with a document for PRN Medication Administration Record In-Service training. The provided document indicated the staff in attendance, topics covered and date and time of the training. The training was conducted on 11/27/2024 at 3:00pm

Based on today's visit, LPAs determined the facility fulfilled the plans of corrections. LPAs cleared the two deficiencies and provided the facility with a copy of this report and one clear letter.
Armando J LuceroTELEPHONE: (949) 430-1222
Dwayne L MasonTELEPHONE: () -
DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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