306002955-1-10-2025-22-AS-EKIM-DCSRMA-20250110120825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002955
Report Date: 01/10/2025
Date Signed: 01/10/2025 12:08:31 PM

Document Has Been Signed on 01/10/2025 12:08 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:	BROOKDALE NOHL RANCH		FACILITY NUMBER:	306002955
ADMINISTRATOR/ DIRECTOR:	SARAH DEVORE		FACILITY TYPE:	740
ADDRESS:	380 S ANAHEIM HILLS RD		TELEPHONE:	(714) 974-1616
CITY:	ANAHEIM HILLS	STATE: CA	ZIP CODE:	92807
CAPACITY: 266		CENSUS: 76	DATE:	01/10/2025
TYPE OF VISIT:	Case Management - Health Checks	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Executive Director- Sarah Devore		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPAs) Edward Kim and Eboni Bentley made unannounced case management visit regarding a self-reported incident on the relocation of 29 residents from Brookdale Ocean House- License # 198204758, 2107 Ocean Ave, Santa Monica, CA 90405, to Brookdale Nohl Ranch -License # 306002955 due to mandatory evacuation orders from Fire Advisory. LPAs met with Administrator Sarah Devore from Brookdale Nohl Ranch and explained the purpose of the visit. During the visit, LPAs Kim and Bentley conducted a health and safety check and no concerns observed. LPA reviewed and obtained resident and staff rosters for both facilities, as well as Fire inspection and testing dated January 24, 2024. Per interview with the licensee, 29 residents have been relocated to Brookdale Nohl Ranch. The facility has sufficient beds, hygiene supplies, beddings, linens, and everyone has a designated room. All rooms have an ensuite bathroom. The activity room is converted to a dining room for the Brookdale Ocean House residents. The dining room is large enough to accommodate all residents with staggered dining schedules. The kitchen has sufficient two-day perishable and seven-day non-perishable food supplies. Medications, MARs, and files of the Brookdale Ocean House residents have been transferred to Brookdale Nohl Ranch and stored in a medical cart in the wellness center. 26 Brookdale Ocean House residents are fully ambulatory, use no assistance devices, and do not require any incontinent care. 3 Brookdale Ocean House residents are non-ambulatory, all three use wheelchairs, and do not require any incontinent care. The Licensee stated both facilities use the same vendors, pharmacy and home health agencies, which allows them to provide the same level of continued care for the residents. The facility also has licensed LVN's on staff at Brookdale Nohl Ranch to care for insulin residents. Report continued in LIC 809-C.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BROOKDALE NOHL RANCH	FACILITY NUMBER: 306002955
	VISIT DATE: 01/10/2025

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There is sufficient staffing available to provide care for resident of both facilities. It has been verified that a routine Fire inspection and testing was completed on January 24, 2024, and a fire drill was conducted on November 18, 2024. The licensee confirmed all families, responsible parties, DMH, regional centers for the Brookdale Ocean House residents have been notified about the relocation either via calls, texts, or emails.

The licensee stated that current Brookdale Nohl Ranch residents will not be affected by this relocation and will not share rooms with Brookdale Ocean House residents.

An exit interview was conducted, and a copy of this report was provided to Executive Director Sarah Devore.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC809 (FAS) - (06/04)

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