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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004718
Report Date: 04/10/2024
Date Signed: 04/10/2024 05:07:37 PM


Document Has Been Signed on 04/10/2024 05:07 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:GROVES OF TUSTIN, THEFACILITY NUMBER:
306004718
ADMINISTRATOR:MIRELLA MANJARREZFACILITY TYPE:
740
ADDRESS:1262 BRYAN AVETELEPHONE:
(714) 730-5009
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:100CENSUS: 62DATE:
04/10/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Liana Foote, Executive DirectorTIME COMPLETED:
09:00 AM
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Licensing Program Analysts (LPAs) Michael Tea and Rose Ruppert with Licensing Program Manager (LPM) Alisa Ortiz made an unannounced visit to the facility today to conduct a Case Management Plan of Correction (POC). LPAs and LPM were greeted and granted entry by Alma Gomez, Memory Care Director. During today's visit LPAs and LPM met with Liana Foote, Executive Director.

The purpose of today's visit was to follow-up in regards to deficiency cited during an annual required visit conducted on March 27, 2024. During inspection the facility was cited California Code of Regulations Title 22 Section 87355(e)(1). The POC was due on March 28, 2024. On this day LPA verified POC was corrected. Deficiency cleared.

An exit interview was conducted and a copy of this report was given to the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: RoseMarie RuppertTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2024
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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