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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005410
Report Date: 06/04/2020
Date Signed: 06/04/2020 05:51:06 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:BROOKDALE YORBA LINDAFACILITY NUMBER:
306005410
ADMINISTRATOR:JEFFREY TOOMERFACILITY TYPE:
741
ADDRESS:17803 IMPERIAL HIGHWAYTELEPHONE:
(714) 777-9666
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:135CENSUS: 81DATE:
06/04/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Alyson Caluza, Health & Wellness CoordinatorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Kathrina Chin contacted the facility via telephone as a follow up to a case management- incident due to COVID-19 and for pre-cautionary measures. LPA Chin identified herself and spoke to LPA spoke Alyson Caluza, Health & Wellness Coordinator regarding several residents who were diagnosed with scabies.


This is a follow up to three incident reports concerning several residents diagnosed with scabies:

On 5/15,2020, one resident(R1) was diagnosed with scabies and treatment is completed.

On 5/22/2020, a second resident (R2) was diagnosed with scabies and continues to receive treatment.


On 5/26/2020, three additional residents were diagnosed with scabies. Ms. Caluza stated that R3 was treated with Elimite cream and R4 and R5 were treated both with oral medications and Elmite cream. R1 continues to receive treatment. Treatment for R4 and R5 have completed their treatment and both are symptom free.

No deficiency cited this review as per Title 22 of the California Code of Regulations.

An exit interview was conducted with Alyson Caluza, HWC via telephone and a copy of this report was provided via email. Alyson Caluza agreed to confirm the receipt of the document and review the report and return a signed copy.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2020
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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