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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005211
Report Date: 07/06/2022
Date Signed: 07/06/2022 11:31:52 AM


Document Has Been Signed on 07/06/2022 11:31 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
CCLD Regional Office, 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:
07/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alexandra BlancarteTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced Case Management visit to follow up on an Unusual Incident report received on 7/4/2022. LPA met with Med Tech/Administrative Assistant Alex Blancarte and explained the reason for today's visit.

During today's visit, LPA toured facility with Staff Blancarte. LPA observed residents exercising in the Activity Room, some watching TV and some asleep in their room. LPA observed one Med Tech, three Caregivers and one Activities Director during today's visit. Facility currently has no Cook as the Cook resigned a week ago. Caregivers and Administrator are currently covering in the kitchen until one is hired. Per Med Tech Alexandra, facility has been interviewing for the position.

On 07/04/2022, Community Care Licensing Division (CCLD) Orange Office received an incident report from the facility. The report stated that on 07/03/2022, Resident 1 (R1) was found by a staff with R1's head pressed against the bed rail and while adjusting R1, staff noticed a purplish discoloration a little larger than a quarter size on R1's right eye.

LPA observed and discussed the half bed rail on R1's bed.

LPA Martinez obtained copies of pertinent documents related to the Incident. This Case Management visit will be completed at a later date. No citation was issued at this time.

An exit interview was conducted and a copy of this report was emailed to Administrator Melinda Flores during this visit.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
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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