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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306002954
Report Date:
06/11/2020
Date Signed:
06/11/2020 04:05:21 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 IRVINE
FACILITY NUMBER:
306002954
ADMINISTRATOR:
MICHAEL ARCEO
FACILITY TYPE:
740
ADDRESS:
10 MARQUETTE
TELEPHONE:
(949) 854-3766
CITY:
IRVINE
STATE:
CA
ZIP CODE:
92612
CAPACITY:
155
CENSUS:
128
DATE:
06/11/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
03:09 PM
MET WITH:
Carrie Galloway - Executive Director
TIME COMPLETED:
04:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Patricia Velazquez
contacted the facility via telephone to conduct a Case Management visit telephonically due to the COVID-19 Pandemic and pre-cautionary
measures. This Case Management visit was conducted in conjunction with a complaint investigation visit with control number 22-AS-20200610155521.
During today's Case Management LPA Velazquez conducted a partial virtual tour of the physical plant utilizing phone FaceTime virtual technology. The virtual tour was conducted along with Executive Director Carrie Galloway. Residents were observed in the interior common areas of the facility where social distancing was observed. Residents were observed in the exterior common areas of the facility and in one area residents were observed sitting closer than 6 feet. ED Galloway was advised to continue to encourage residents to maintain a minimum of 6 feet of social distancing.
There were no deficiencies issued during this Case Management visit. An exit phone interview was conducted with Executive Director Carrie Galloway and a copy of this report was signed by LPA Patricia Velazquez.
This report will be sent via email to ED Galloway who agrees to sign and date the report. This report was sent via email and an electronic read receipt confirms receiving the report. ED Carrie Galloway agrees to send the original report by mail to the CCLD Regional Office (RO) in Orange. LPA Velazquez provided the RO address to ED Galloway.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2870
LICENSING EVALUATOR NAME:
Patricia Velazquez
TELEPHONE:
(714) 380-0440
LICENSING EVALUATOR SIGNATURE:
DATE:
06/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/11/2020
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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