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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004718
Report Date: 01/30/2025
Date Signed: 01/30/2025 11:42:48 AM

Document Has Been Signed on 01/30/2025 11:42 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:GROVES OF TUSTIN, THEFACILITY NUMBER:
306004718
ADMINISTRATOR/
DIRECTOR:		MCBRIDE, FERLINAFACILITY TYPE:
740
ADDRESS:1262 BRYAN AVETELEPHONE:
(714) 730-5009
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 100TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
01/30/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Debbie Garibaldi - Resident Care Director TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a case management visit. LPA was greeted and granted entry into facility Debbie Garibaldi, Resident Care Director and explained the reason for the visit.

The Department received an Unusual Incident/Injury Report LIC 624 for Resident 1 (R1) it was reported that on 01/20/2025 complained of pain to Staff 1 (S1). S1 then called Debbie, Resident Care Director. Debbie checked on R1 and called non emergent ambulance. R1 was taken to the hospital and responsible party was notified. R1 received a CAT scan and was diagnosed with a fracture. R1 was then taken back to the facility with new medication orders. R1 then had a follow up with orthopedics 01/24/2025 and they are currently waiting authorization for MRI.

R1 is currently back at the facility and appears well groomed.


No deficiencies cited. An exit interview was conducted and a copy of this report was provided.
Alisa OrtizTELEPHONE: (714) 703-4084
Andrea MendivilTELEPHONE: 714-703-2738
DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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