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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004753
Report Date: 07/14/2021
Date Signed: 07/14/2021 02:14:16 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:VALLEY VIEW GARDENSFACILITY NUMBER:
306004753
ADMINISTRATOR:JESUS SOTO FLORESFACILITY TYPE:
740
ADDRESS:11848 VALLEY VIEW STREETTELEPHONE:
(714) 895-9898
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY:72CENSUS: 34DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jesus SotoTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Executive Director Jesus Soto and explained the reason for the visit. Facility specializes in memory care.

At 9:45 AM, LPA toured the facility with Executive Director Soto. Facility has 34 residents in care during today's visit. LPA observed residents relaxing in common areas of the facility as well as participating in activities. All residents appeared happy and well taken care of. Facility appears clean and sanitary. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the entrance of the facility. Facility utilizes a visitor sign in sheet. Facility takes resident temperatures daily and documents. Facility has covid precaution postings as well as all required department postings. Administrator Jesus Soto has an administrator certificate expiring on 08/31/2021. Facility mitigation plan has been approved. LPA observed ample emergency food and water as well as multiple first aid kits throughout the facility. LPA observed a large outside visitation area with shaded areas. LPA toured the kitchen area and facility has an ample supply of PPE and cleaning supplies. LPA observed the medication room as well as medication carts. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. LPA reviewed select files and all contained required documentation as well as updated emergency information.

No citations noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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