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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002915
Report Date: 07/21/2021
Date Signed: 07/21/2021 12:12:05 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:BROOKDALE ANAHEIMFACILITY NUMBER:
306002915
ADMINISTRATOR:TROY BYINGTONFACILITY TYPE:
740
ADDRESS:200 N DALE STTELEPHONE:
(714) 761-5771
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:140CENSUS: 88DATE:
07/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Troy ByingtonTIME COMPLETED:
12:22 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual visit. LPA was greeted and granted entry by Executive Director (ED) Troy Byington. LPA Alejandre and ED Troy Byington toured the facility. Facility is a 3 story building with an interior courtyard. LPA inspected the common areas including the kitchen, dining room, front lobby, courtyard. LPA and ED also toured the memory care area which is on the first floor. LPA toured the medication room on the first floor. All medications were secured in the medication carts. LPA observed all fire extinguishers are fully charged. LPA did not observe any obstacles or hazards. LPA toured the outside of the building and parking area, LPA did not observe any obstacles or hazards. LPA has reviewed the facility's Covid-19 mitigation plan. Mitigation plan is in accordance with CCL guidelines. LPA discussed mitigation plan and procedures with Executive Director. LPA reviewed activity calendar. LPA observed the facility is organized and clean. Based on Title 22 Division 6 of the California Code of Regulations, no deficiencies are being cited as a result of this visit. Exit interview conducted with Troy Byington and a copy of this report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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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