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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004447
Report Date: 08/15/2024
Date Signed: 08/15/2024 04:56:42 PM

Document Has Been Signed on 08/15/2024 04:56 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CRESCENT RESIDENTAL HOMEFACILITY NUMBER:
306004447
ADMINISTRATOR/
DIRECTOR:
LAUREN LUFACILITY TYPE:
735
ADDRESS:7150 CRESCENT AVENUETELEPHONE:
(714) 761-2695
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
08/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Jenalou CadampogTIME VISIT/
INSPECTION COMPLETED:
05:05 PM
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Licensing Program Analysts (LPA) Jerome Haley and Samer Haddadin conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPAs were greeted, granted entry by staff, and explained the reason for the visit before entering the facility.

Around 2:20 pm LPA Haley began the tour of the facility with staff. There were six clients present during the visit. All client bedrooms were clean, organized, and had all the necessary requirements: night stand, chair, lamp, and storage space. Client bathrooms were clean and well organized. Hot water temperature was measured in the range of 105.8 – 107 degrees Fahrenheit.

The kitchen was clean and organized. All knives and sharp objects were locked in a drawer near the sink. All burners on the stove were operational. The facility has a two-day supply of perishable food items and seven-day supply of nonperishable food items.

In between the kitchen and garage is an office area. In the office area is a locked medication cabinet, and a cabinet with staff and resident files. In the office area is where the first aid supplies are kept, including a first aid manual.

The garage was clean, organized, and walkways were free of obstruction. There’s a washer and dryer in the garage and a locked cabinet with a supply of cleaning materials. There’s an additional refrigerator in the garage for the clients with an additional supply of food items. Buckets of emergency food, emergency supplies, emergency bags for the clients, and an emergency supply of water was observed.

The backyard was clean and well organized. Walkways were free of obstruction. There's shaded area with chairs and a bench. Three storage sheds were observed in the backyard with miscellaneous facility items. Side exits gates were self-latching.

Continued on LIC809C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CRESCENT RESIDENTAL HOME
FACILITY NUMBER: 306004447
VISIT DATE: 08/15/2024
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There were no bodies of water observed. All smoke detectors were tested and are operational. The carbon monoxide detector tested operational. Emergency evacuation drills are conducted monthly, and the last drill was conducted August 5, 2024. A review of all client files and P&I funds was conducted. 4 staff files were reviewed, and 4 of 6 client medications were reviewed.

No deficiencies are being cited during today’s visit. An exit interview conducted, and a copy of the report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC809 (FAS) - (06/04)
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