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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004753
Report Date: 07/05/2022
Date Signed: 07/05/2022 03:26:26 PM


Document Has Been Signed on 07/05/2022 03:26 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:CRESCENT LANDING AT GARDEN GROVE MEMORY CAREFACILITY NUMBER:
306004753
ADMINISTRATOR:JESUS SOTO FLORESFACILITY TYPE:
740
ADDRESS:11848 VALLEY VIEW STREETTELEPHONE:
(714) 895-9898
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY:72CENSUS: 27DATE:
07/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Jesus SotoTIME COMPLETED:
02:00 PM
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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 12:36 PM, LPA toured the facility with Executive Director Soto. Facility has 27 residents in care during today's visit with one on hospice care. LPA observed residents relaxing in common areas of the facility preparing to eat lunch. 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 an electronic visitor sign in sheet. Facility takes resident temperatures daily and documents. Facility has covid precaution postings as well as required department postings. Administrator Jesus Soto has an administrator certificate expiring on 08/31/2023. Facility mitigation plan has been approved. Facility smoke detectors and sprinklers are inspected yearly by an outside company, Cal Building Systems and the last inspection was on 08/20/2021. 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 2 day perishables and 7 day non-perishables. Facility has an ample supply of PPE and cleaning supplies. LPA observed the medication room and 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 updated emergency information.

LPA consulted with Administrator on the importance of posted hand washing signs in all communal restrooms as well as posting the emergency disaster plan in the entrance of the facility. Additionally, LPA consulted on posting the "Let Us No" poster in regulation size, "20 X 26".
Based on the observations made during today's visit, 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: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
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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