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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306004721
Report Date:
11/23/2020
Date Signed:
11/23/2020 03:18:10 PM
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:
BROOKDALE SAN JUAN CAPISTRANO
FACILITY NUMBER:
306004721
ADMINISTRATOR:
JOSEPH FRANZ
FACILITY TYPE:
741
ADDRESS:
31741 RANCHO VIEJO RD
TELEPHONE:
(949) 248-8855
CITY:
SAN JUAN CAPISTRANO
STATE:
CA
ZIP CODE:
92675
CAPACITY:
125
CENSUS:
45
DATE:
11/23/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Joseph Franz, Cindy Garcia
TIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced joint visit to the facility with the Orange County Health Care Agency (OCHCA) staff. LPM and LPA and OCHCA staff were greeted and granted entry by Assisted Living Director Cindy Garcia. OCHCA staff and LPM Ortiz and LPA Alejandre discussed with the Executive Director and Assisted Living Director procedures to help mitigate the spread of Covid-19. The Assisted Living Director along with the Executive Director toured the facility with OCHCA staff and LPM Ortiz and LPA Alejandre. After the tour and brief discussion on quarantine and isolation practices OCHCA staff left the facility. LPM Ortiz and LPA Alejandre reviewed resident files. No deficiencies are being cited as a result of this visit. An exit interview was conducted with Executive Director Joseph Franz and Assisted Living Director Cindy Garcia. A copy of this report was provided to the facility.
SUPERVISOR'S NAME:
Alisa Ortiz
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
11/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/23/2020
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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