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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005257
Report Date: 04/29/2022
Date Signed: 04/29/2022 10:05:53 AM


Document Has Been Signed on 04/29/2022 10:05 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: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: 95DATE:
04/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Robert Janiki, AdministratorTIME COMPLETED:
10:25 AM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted a case management visit for the purpose of delivering an amended LIC9099 to the facility.
Following the amendment of the forms related to complaint 22-AS-20211129083243, LPA conducted a visit on 04/05/2022 for the purpose of delivering form LIC9099-D which had been omitted by the former LPA in charge of the complaint investigation. However the amended version of the original LIC9099 was not delivered on 04/05/2022 and is now being provided to be signed by a facility representative.
An exit interview was conducted and copy of this report has been provided along with the amended LIC9099.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022
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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