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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005211
Report Date: 12/06/2023
Date Signed: 12/06/2023 09:18:44 AM


Document Has Been Signed on 12/06/2023 09:18 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: 22DATE:
12/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Fabiola Fuentes
Melinda Olivarez - Administrator		TIME COMPLETED:
09:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jerome Haley conducted a case management visit regarding information discovered during the investigation into complaint control # 22-AS-20231103104532.

During the complaint investigation mentioned above, it was discovered Staff 5 (S5) was working in the facility without being associated. It was discovered S5 was rehired in June of 2023 and is scheduled to work Tuesday – Saturday on the NOC (overnight) shift.

S5’s employment and presence in the facility is confirmed by Administrator (AD) Melinda Olivarez, who provided dates of employment, and work schedule, and an LIC500 with S5’s name written on the document dated November 7, 2023. During the investigation into complaint control # 22-AS-20231103104532, Staff 4 (S4) confirmed working with S5, and wrote S5’s name on an incident report (LIC624) dated November 1, 2023 that was faxed and received at the Regional Office November 3, 2023.

As of November 7, 2023, S5 was not associated with the facility, and S5’s name was not on the staff roster that was printed by the department. S5 was not listed and associated on the facility roster until December 2, 2023.

As a result of today’s Case Management visit, deficiencies will be cited.

An exit interview was conducted and a copy of this report, LIC809D, and appeal rights were provided.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
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 12/06/2023 09:18 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868


FACILITY NAME: ARDENT CARE
FACILITY NUMBER: 306005211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/13/2023
Section Cited
CCR
87735(e)(1)

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87355 Criminal Record Clearance (e) "All individuals subject to a criminal record review...(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department..."
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Licensee to review regulation section 87355 Criminal Record Clearance and submit a signed statement of understanding and acknowledgement of the regulation requirements. POC can be sent to LPA via email and is due by Tuesday, December 12, 2023 at 1:00PM
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This requirement is not met as evidenced by:
Based on observations, interviews, and record review, S5 was working in the facility without being associated according to regulation guidelines. This poses a potential safety threat to residents in care.
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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: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2