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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003860
Report Date: 04/17/2024
Date Signed: 04/17/2024 04:28:31 PM

Document Has Been Signed on 04/17/2024 04:28 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:ELIZABETH HOMES/NEPTUNE DRIVEFACILITY NUMBER:
306003860
ADMINISTRATOR/
DIRECTOR:		ELIZABETH SANTOSFACILITY TYPE:
735
ADDRESS:8439 NEPTUNE DRIVETELEPHONE:
(714) 821-8651
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 5DATE:
04/17/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Maxine Kniazeff - AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Jerome Haley made an unannounced Case management visit to follow up on a death reported to the Regional Office April 16, 2024. LPA Haley was greeted, granted entry, and explained the reason for the visit with staff. Staff contacted Administrator Maxine Kniazeff who arrived a short time later and was present for the remainder of the visit.

Upon entering the facility, a Health and Safety check was conducted on the five client’s present at the time of the visit. Client’s were observed in the dining room or in their bedroom. One client was in his bed sleeping.

After the health and Safety check LPA Haley completed a questionnaire with Administrator Maxine Kniazeff.

An LIC500, client roster, and documents for Client 1 (C1) were provided during the visit.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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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