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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003060
Report Date: 05/31/2024
Date Signed: 05/31/2024 11:56:23 AM


Document Has Been Signed on 05/31/2024 11:56 AM - 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:WEST GLENN MANORFACILITY NUMBER:
306003060
ADMINISTRATOR:ROSARIO NAZARENOFACILITY TYPE:
740
ADDRESS:7242 WESTMINSTER BLVD.TELEPHONE:
(714) 898-2131
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:98CENSUS: 85DATE:
05/31/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Rosario Nazareno and Benly BandolaTIME COMPLETED:
12:10 PM
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On May 31, 2024, at 8:10am Licensing Program Analyst (LPA) Edward Kim arrived to complete the required 1-Year annual visit that was started May 28, 2024. LPA Kim was greeted and granted entry by Administrator (AD) Rosario Nazareno and explained the purpose of the visit.

During the visit, LPA Kim conducted an audit of staff files (S1-S9), resident files (R1-R9), nine (9) resident medication and medication administration record, nine (9) resident interview, and Nine (9) staff interviews. The first aid kit was reviewed and contained all the required items.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report was provided to Administrator Rosario Nazareno.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (916) 956-7332
LICENSING EVALUATOR NAME: Edward KimTELEPHONE: (714) 293-1237
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024
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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