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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005257
Report Date: 07/22/2022
Date Signed: 07/22/2022 11:34:14 AM


Document Has Been Signed on 07/22/2022 11:34 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:
07/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Executive Director Robert JakiniTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Claudia Gutierrez and Joseph Alejandre made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPAs met with Executive Director (ED) Robert Jakini, Administrator certificate expires 7/23/23. LPAs discussed the purpose of the inspection. During the inspection LPAs and ED conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and observed the following:

This is a two-story complex with an adjacent two-story building for Memory Care. Residents were observed resting in their respective rooms and engaging in the following leisure activities throughout the facility: singing, watching television, and doing puzzles/board games. Upon entry LPAs noted a hand sanitizer station. The necessary signage postings: residents' rights, license, theft and loss policy, ombudsman, and PUB475 (see something, say something poster) were observed. LPAs noted hallways and walk ways were free of obstruction. A 2-day supply of perishable and a 7-day supply of non-perishable food was observed during today’s visit. All fire extinguisher observed were found to be within regulation. An emergency evacuation chair was present at the stairwell. A fountain in the courtyard was observed to be empty of water. No bodies of water were observed during today's visit.

LPA Gutierrez reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, infection control training, PPE, staffing and staffing shortages.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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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