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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004530
Report Date: 05/13/2022
Date Signed: 05/13/2022 03:33:49 PM

Document Has Been Signed on 05/13/2022 03:33 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:PRIME CARE MANORFACILITY NUMBER:
306004530
ADMINISTRATOR:ABDOL ARASTOOFACILITY TYPE:
735
ADDRESS:8592 LAMPSON AVENUETELEPHONE:
(714) 534-4457
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 26CENSUS: 23DATE:
05/13/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Licensee Marjan Arastoo and Administrator Abdul ArastooTIME COMPLETED:
03:30 PM
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Regional Manager (RM) Marina Stanic, Licensing Program Managers (LPMs) Sheila Santos, Lucy Adams and Armando Lucero; and Licensing Program Analyst (LPAs) Albert Marin, Sean Haddad and Edward Tapia met with Licensee and Administrator (AD) Marjan Arastoo, and AD Abdul Arastoo. RM Stanic stated the purpose of office meeting.

The purpose of the office meeting was to finalize and sign the compliance plan set during the Non-Compliance Conference (NCC) completed last May 10, 2022 via video teleconference.

LPA Marin conducted an exit interview with ADs M. Arastoo and A. Arastoo. LPA provided Copies of this report and NCC report to the ADs.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2022
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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