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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005211
Report Date: 08/14/2024
Date Signed: 08/14/2024 11:06:08 AM


Document Has Been Signed on 08/14/2024 11:06 AM - 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:ARDENT CAREFACILITY NUMBER:
306005211
ADMINISTRATOR:MELINDA FLORESFACILITY TYPE:
740
ADDRESS:1665 SOUTH BROOKHURST STREETTELEPHONE:
(714) 991-0991
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:27CENSUS: 24DATE:
08/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Melinda Flores - AdministratorTIME COMPLETED:
11:21 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of conducting a required annual inspection. LPA was greeted at the facility by Fabiola Fuentes, Medtech/Caregiver. LPA met with Melinda Flores, Administrator and explained the purpose of the inspection.

The facility is one-story building with twelve shared resident bedrooms, two private resident bedrooms, each with their own bathroom. The facility also has two common bathrooms, kitchen, dining room, office, medication room, activity room, caregiver station, shower room, laundry room, living room, courtyard and outdoor storage. Facility appears clean, safe and sanitary. LPA observed the facility has the necessary postings posted on the walls. LPA noted residents were lounging in their rooms or the living room.

All resident rooms had the required elements, including bed, chair, closet space and ample lighting. Facility has extra linens and hygiene supplies for residents in a storage room. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured between 105 and 120 degrees F. LPA observed facility has emergency food and water supply as well as additional emergency supplies. LPA observed the fire extinguisher was last serviced on October 2, 2023. Smoke/Carbon Monoxide detector/fire alarm were tested and noted as operational. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in the kitchen, storage or the laundry room. Knives are locked up separate from toxic chemicals. Medication for each resident is kept locked in the medication room. The courtyard has shaded sitting/lounging areas. Exit gates are unlocked. LPA observed exit gates to be unobstructed. Based on record review, LPA observed the medication administration record for four residents to be missing signatures. A deficiency is being issued. LPA reviewed four resident files and four staff files. LPA also reviewed medication for four residents. LPA interviewed one staff and two residents.

Based on today's inspection, one deficiency is being issued. An exit interview was conducted and a copy of this report and appeal rights were provided to the facility.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 08/14/2024 11:06 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: ARDENT CARE
FACILITY NUMBER: 306005211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(c)(3)
Incidental Medical and Dental Care Services
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.

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 in 4 medication records out of 4 medication records. Each reviewed record had missing signatures from medication administered to residents. This causes a potential personal rights risk to persons in care.
POC Due Date: 08/21/2024
Plan of Correction
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Administrator stated they will conduct an in-service training focusing on medication administration and medication documentation. AD will send to LPA via email a list of attendees at the training and a summary of the topics covered by the assigned POC due date of 8/21/2024.
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 LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024
LIC809 (FAS) - (06/04)
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