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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004823
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:13:12 PM

Document Has Been Signed on 01/24/2024 12:13 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:LEISURE TOWER II RESIDENTIAL CAREFACILITY NUMBER:
306004823
ADMINISTRATOR:NELSON PEREZFACILITY TYPE:
735
ADDRESS:608 E SYCAMORETELEPHONE:
(714) 321-1656
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 32CENSUS: 28DATE:
01/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Nelson Perez
Stephanie Perez		TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Elizabeth Thomas. LPA met with Administrator (AD) Nelson Perez and explained the purpose of the inspection. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, client bedrooms, kitchen, garage and observed the following:

This is a two-story apartment complex with nine apartments. Eight of the nine apartments are occupied by clients and contain two bedrooms, and one bathroom. One out of nine of the apartments serves as a dining area for clients and as a staff office. All client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. LPA observed all windows were screened. The courtyard has a shaded sitting area. LPA observed clients smoking in the designated smoking area, resting in their apartments and respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. LPA tested the water temperature in seven out of eight client bathrooms; water temperature tested between 108.8-116.0 F degrees. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguishers were observed mounted on the wall on the first and second story, and were observed to be fully charged with a service tag dated 2/01/23. All appliances tested operable. Sharps, all and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients. Medication cabinet was observed to be locked. LPA reviewed six client files and four staff files. Staff file review indicated first aid cards had expired for staff present in August and November of 2023. AD stated staff had received first aid training, but was unable to provide LPA with a copy of current, unexpired first aid cards for staff; a Deficiency was cited on today’s date. LPA interviewed six clients and three staff.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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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Document Has Been Signed on 01/24/2024 12:13 PM - It Cannot Be Edited


Created By: Claudia Gutierrez On 01/24/2024 at 11:07 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LEISURE TOWER II RESIDENTIAL CARE
FACILITY NUMBER: 306004823

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(f)
Health-Related Services
(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as staff currently present, responsible for providing direct care and supervision, do not hold current, unexpired first aid cards, which poses a potential health and safety risk to persons in care.
POC Due Date: 02/24/2024
Plan of Correction
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AD stated they would provided LPA with proof of staffs' first aid training and card renewal via email by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: LEISURE TOWER II RESIDENTIAL CARE
FACILITY NUMBER: 306004823
VISIT DATE: 01/24/2024
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Based on the observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview with secondary Administrator Stephanie Perez was conducted and a copy of this report and appeals rights was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC809 (FAS) - (06/04)
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