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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003860
Report Date: 03/01/2022
Date Signed: 03/01/2022 10:47:12 AM

Document Has Been Signed on 03/01/2022 10:47 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:ELIZABETH HOMES/NEPTUNE DRIVEFACILITY NUMBER:
306003860
ADMINISTRATOR:ELIZABETH SANTOSFACILITY TYPE:
735
ADDRESS:8439 NEPTUNE DRIVETELEPHONE:
(714) 821-8651
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH: Maxine Kniazeff, AdministratorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit for the purpose of conducting a required annual inspection visit. LPA arrived at facility, explained the purpose of the visit and was greeted by caregiving staff and granted entry after a temperature check. Staff called the Administrator Maxine Kniazeff who arrived shortly afterwards.

At approximately 10:20am, LPA accompanied by Administrator began the tour of the facility. There are currently six (6) residents in care, including one non-ambulatory. The residents are observed relaxing in the common areas or in their bedrooms and appear well taken care of. Facility appears to be clean, sanitary and free of odors in all areas inspected. Each of the six (6) bedroom is observed to have all required components and bathrooms are equipped with grab bars and slip mats.
LPA observed a check-in station right at the entrance of the facility where temperature checks are being documented for visitors. LPA observed the facility has COVID-19 Precautions posters, all required department postings and hand washing signs are posted throughout. LPA observed a sufficient supply of food and water. Facility has an adequate supply of PPE accessible in proximity to the check-in station.
LPA toured the outside of the facility and observed outdoor seating for the residents' enjoyment. Outdoor space is free of debris and well-maintained with a self-latching gate that can easily be opened on one side of the house. The facility has completed and submitted their LIC808 Mitigation Plan.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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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