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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306004516
Report Date:
01/29/2024
Date Signed:
01/29/2024 10:59:36 AM
Document Has Been Signed on
01/29/2024 10:59 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:
ALPER'S CARE HOME
FACILITY NUMBER:
306004516
ADMINISTRATOR:
ALPER OZDEMIR
FACILITY TYPE:
740
ADDRESS:
12192 MAGNOLIA STREET
TELEPHONE:
(714) 539-3735
CITY:
GARDEN GROVE
STATE:
CA
ZIP CODE:
92841
CAPACITY:
6
CENSUS:
6
DATE:
01/29/2024
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
09:50 AM
MET WITH:
Nurten Ozdemir
TIME COMPLETED:
11:18 AM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced plan of correction (POC) visit to follow up on citation issued on 01/19/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit.
Deficiency cited under Title 22 Regulation
87608(a)(5)(B)
pertaining to postural supports has NOT been cleared. Resident 1 has full rails on the bed. Licensee has not complied with the terms of the POC. CIVIL PENALTY ASSESSED.
Licensee has been advised to maintain all items especially those that were previously deficient in the facility in accordance with Title 22 Regulations.
Exit interview conducted and a copy of this report was provided to the facility.
SUPERVISOR'S NAME:
Alisa Ortiz
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Kimberly Lyman
TELEPHONE:
(714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE:
01/29/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/29/2024
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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