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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004447
Report Date: 08/31/2021
Date Signed: 08/31/2021 12:29:28 PM

Document Has Been Signed on 08/31/2021 12:29 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:CRESCENT RESIDENTAL HOMEFACILITY NUMBER:
306004447
ADMINISTRATOR:LAUREN LUFACILITY TYPE:
735
ADDRESS:7150 CRESCENT AVENUETELEPHONE:
(714) 761-2695
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
08/31/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Lauren Lu, AdministratorTIME COMPLETED:
12:50 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) 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 and explained the nature of the visit. Administrator arrived shortly after and met with LPA.

LPA Martinez accompanied by Administrator toured the facility. There are six clients in the facility and there are no active covid-19 cases. LPA observed five clients in the dinning room having lunch and one client in their bedroom. All residents appeared clean and well taken care of. LPA observed required department postings, covid-19 precautionary postings in the facility as well as hand washing signs in the restrooms. All restrooms observed had ample soap/sanitizer and appeared clean. Resident bedrooms appeared clean and sanitary and had all required components. LPA Martinez observed a check in station in the main entry of the facility. Facility is taking clients and staff temperatures daily and documenting results. LPA observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies. Facility has completed the LIC808 Mitigation Plan.

Based on the observations 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 Administrator and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2021
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 1