<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003527
Report Date: 09/28/2022
Date Signed: 09/28/2022 02:25:31 PM


Document Has Been Signed on 09/28/2022 02:25 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:YORBA LINDA SENIOR CAREFACILITY NUMBER:
306003527
ADMINISTRATOR:CHRISTOPHER CURTISFACILITY TYPE:
740
ADDRESS:4451 ACORN COURTTELEPHONE:
(714) 993-0449
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:6CENSUS: 0DATE:
09/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Christopher Curtis - Administrator TIME COMPLETED:
02:40 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 (LPA) Patricia Velazquez conducted an unannounced visit to Yorba Linda Senior Care. The purpose of today's visit was to conduct a Required 1 Year inspection focusing primarily on Infection Control. LPA Velazquez was allowed entry into the facility and met with Administrator Christopher Curtis. The facility is licensed for 6 non-ambulatory residents. The facility also has a Hospice waiver for 2 residents. There are currently no residents living in the facility.



At 1:47 PM LPA Velazquez conducted a tour of the physical plant along with Admin Curtis. The 1 story home consists of 5 resident bedrooms with 2 bathrooms and 1 staff bedroom. The facility also has a living room, dining room, and kitchen. The facility also had a sign in area where temperature is checked and PPE available. The resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew and a non-skid surface or mat was in place. Resident bath towels and personal hygiene supplies will be adequately stocked. LPA Velazquez tested the hot water temperature in the resident bathroom and the temperature measured at 130.1 degrees Fahrenheit in the bathroom which Administrator Curtis verified. Administrator Curtis immediately lowered the water heater temperature. Handwashing instructions were posted in the bathroom with soap and paper towels available in the resident bathroom.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: YORBA LINDA SENIOR CARE
FACILITY NUMBER: 306003527
VISIT DATE: 09/28/2022
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
26
27
28
29
30
31
32
LPA Velazquez inspected the kitchen along with Administrator Curtis. Perishable and non-perishable food supply was checked and will be adequately stocked when the facility once again accepts residents. LPA and Admin observed the knives and other sharps were stored in a locked drawer in the kitchen and inaccessible to residents. Resident medications will be stored in a locked closet in the entry way of the facility. The fire extinguishers were fully charged. The smoke and carbon monoxide detectors were tested and found to be operational. The facility will install additional auditory alarms throughout the facility prior to accepting residents back into the facility.

LPA Velazquez along with Administrator Curtis toured the outside grounds. There were no bodies of water present. There was shading and sufficient seating for residents. The exit gate had a self-closing latch. There were no security bars or weapons on the premises.


No resident or staff files were reviewed at the time of this visit and a resident medication review was not conducted as this inspection focused primarily on Infection Control and there are no residents currently living in the facility.


There were no deficiencies issued during this Required 1 Year inspection. An exit interview was conducted with Administrator Christopher Curtis and a copy of this report was provided at the time of this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2