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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005257
Report Date: 11/04/2021
Date Signed: 11/04/2021 12:50:45 PM

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:CRESCENDO SENIOR LIVINGFACILITY NUMBER:
306005257
ADMINISTRATOR:DALE WOYTEKFACILITY TYPE:
740
ADDRESS:351 EAST PALM DRIVETELEPHONE:
(714) 528-4990
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:138CENSUS: 86DATE:
11/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Dale WoytekTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Norman Woodridge conducted a Covid-19 Annual Inspection at the facility. Upon arrival, LPA signed in and completed a temperature check. LPA met with Administrator, Dale Woytek (AD), informed AD of the purpose of the visit, and conducted a tour of the inside and outside of the facility, common areas, kitchen, bedrooms, and bathrooms.

LPA discussed and observed the following:

LPA observed Covid-19 station with sign in sheet, hand sanitizer, and disinfectant wipes. The sign in sheet also included a Covid-19 symptom questionnaire. The facility requires temperature checks for residents, visitors, and staff. LPA observed 30-day PPE supply. Hallways and walkways were free from obstruction. LPA reviewed Covid-19 Mitigation Plan and confirmed mitigation plan was approved by regional office (RO). LPA reviewed Covid-19 records including training records, relevant PINS, and screenings sheets. LPA and AD discussed surveillance testing, staffing, Covid-19 related signage, and Covid-19 reporting requirements.

No deficiencies were noted during the inspection.

An exit interview was conducted with AD and a copy of this report was provided.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Norman WoodridgeTELEPHONE: (714) 703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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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