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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003408
Report Date: 03/03/2022
Date Signed: 03/03/2022 11:57:38 AM


Document Has Been Signed on 03/03/2022 11:57 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:OCEAN RETREATFACILITY NUMBER:
306003408
ADMINISTRATOR:CARINA DEMMANFACILITY TYPE:
740
ADDRESS:6021 PRISCILLA DRIVETELEPHONE:
(714) 898-2646
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 4DATE:
03/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Carina Demman, AdministratorTIME COMPLETED:
12:13 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by caregiver. LPA explained the nature of the visit to caregiver. Carina Demman, Administrator arrived shortly after and met with LPA.

LPA Martinez began the tour of the inside and outside of the facility. There are four residents in care and there are no active covid-19 cases in the facility. LPA observed three residents in the living room watching television and one resident in their bedroom. All residents appeared to be clean and well taken care of. LPA observed a check in station in the main entry of the facility. Facility is taking temperature daily and documentation the results. LPA observed required Department postings, covid-19 precautionary postings, and hand washing signs throughout the facility. All restrooms observed to have soap and appeared to be clean. LPA inspected residents’ bedrooms and observed to be clean and sanitary. All bedrooms were observed to have all required components. LPA observed the emergency disaster and evacuation plan. Facility has supply of emergency food as well as supply of PPE in the facility. LPA toured the outside of the facility and observed two shaded seating areas for resident enjoyment. Facility has submitted their LIC808 Mitigation plan and plan was approved by the Department on April 30, 2021.

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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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