<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005347
Report Date: 11/15/2022
Date Signed: 11/15/2022 11:01:09 AM


Document Has Been Signed on 11/15/2022 11:01 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:DOCTORS TLC ASSISTED LIVING IIFACILITY NUMBER:
306005347
ADMINISTRATOR:MCGARRY, MARISSAFACILITY TYPE:
740
ADDRESS:18422 MANITOBATELEPHONE:
(949) 466-7620
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:6CENSUS: 3DATE:
11/15/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alisa Ortiz, Licensing Program Manager (LPM) Rosie Quiroz Licensing Program Analyst (LPA) and Jenifer Tirre, Licensing Program Analyst (LPA) and Eric Pastrmac, Licensee/ Administrator.TIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On today's date, Licensing Program Manager (LPM) Alisa Ortiz, Licensing Program Analysts (LPAs) Rosie Quiroz and Jenifer Tirre met on this day with Licensee/ Administrator Eric Pastrmac for the purpose of discussing change of ownership. Present during visit via telephone was Licensee Broker/Consultant Greg Parrah.

The following was discussed:

  • Licensee's responsibilities of facility oversight including providing all residents and responsible parties with a written 60 day Notice of Change of Ownership.
  • Licensee is to submit a copy of written 60 Day Notice to the Ombudsman and Community Care Licensing Agency.
  • Update on facility change of application status.
  • Licensee was notified that all complaint investigations will be completed thoroughly by the department regardless of facility closure.

The following items are to be provided to the Department:
  • Lease back Agreement
  • Management Agreement

An exit interview was conducted with Licensee/Administrator Eric Pastrmac. A copy of this report, LIC 809 was provided at exit and via email.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022
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 1