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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004530
Report Date: 11/18/2021
Date Signed: 11/18/2021 02:17:15 PM

Document Has Been Signed on 11/18/2021 02:17 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: DATE:
11/18/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator (AD) Abdol ArastooTIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPAs) Albert Marin and Lydia Martinez made an announced visit to conduct a case management. LPAs met with Administrator (AD) Abdol Arastoo and stated the purpose of this visit.

The purpose of this visit is to conduct health and safety checks; and to assist the representatives from Behavioral Health Services of Orange County Health Care Agency, patients' right advocates and behavioral health services agencies in evaluating clients to determine the appropriateness and the level of care that each needs.

LPAs Marin and Martinez conducted a tour of the interior and exterior portions of the facility. LPAs inspected the clients' rooms, and common areas which included but not limited to dining area, kitchen and patio.

No citation has been issued at this time.

LPA Marin conducted an exit interview with Administrator Abdol Arastoo. Due to technical issues, a copy of this report will be provided to AD via email.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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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