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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005211
Report Date: 02/09/2023
Date Signed: 02/09/2023 03:58:05 PM


Document Has Been Signed on 02/09/2023 03:58 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:ARDENT CAREFACILITY NUMBER:
306005211
ADMINISTRATOR:MELINDA FLORESFACILITY TYPE:
740
ADDRESS:1665 SOUTH BROOKHURST STREETTELEPHONE:
(714) 991-0991
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:27CENSUS: DATE:
02/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Mabel Ramirez- Med Tech TIME COMPLETED:
04:15 PM
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 Licensing Program Analysts (LPA) Andrea Mendivil,made an unannounced visit to Ardent Care in conjunction with a complaint visit control number 22-AS-20230208145448. The purpose of this visit was to conduct a health and safety evaluation.

Residents in care appeared to be safe, no imminent health and safety hazards were observed. LPA observed residents in their respective rooms and in the activity room. LPA observed residents to be well groomed and no visible injuries noted.

No deficiencies were cited during this visit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023
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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