<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005410
Report Date:
06/18/2021
Date Signed:
06/18/2021 10:03:08 AM
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:
SERENTO ROSA
FACILITY NUMBER:
306005410
ADMINISTRATOR:
JEFFREY TOOMER
FACILITY TYPE:
741
ADDRESS:
17803 IMPERIAL HIGHWAY
TELEPHONE:
(714) 777-9666
CITY:
YORBA LINDA
STATE:
CA
ZIP CODE:
92886
CAPACITY:
135
CENSUS:
45
DATE:
06/18/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
08:57 AM
MET WITH:
Liyon O'Quinn
TIME COMPLETED:
10:10 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
Licensing Program Analyst (LPA) Jim August conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into the facility by Executive Director Liyon O'Quinn and explained the reason for the visit.
LPA August toured the facility with Liyon O'Quinn. There are no active covid-19 cases. The facility was clean and all staff were observed wearing masks. Residents were observed social distancing. The facility has ample PPE supplies. LPA observed required department postings in the facility as well as hand washing signs. There is a portable hand washing station at the entrance of the dining area. Facility is taking visitor temperatures and documenting results. Facility has completed the LIC 808 mitigation plan.
No citations noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME:
Sheila Santos
TELEPHONE:
(714) 703-2857
LICENSING EVALUATOR NAME:
James August
TELEPHONE:
714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE:
06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/18/2021
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