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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005441
Report Date: 09/13/2022
Date Signed: 09/13/2022 05:20:29 PM


Document Has Been Signed on 09/13/2022 05:20 PM - 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:FOUNTAIN VALLEY SENIOR HOMESFACILITY NUMBER:
306005441
ADMINISTRATOR:ALMIRANEZ, ULDARICOFACILITY TYPE:
740
ADDRESS:18561 SANTA ISADORATELEPHONE:
(949) 290-6006
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
09/13/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH: Alisa Ortiz,Licensing Program Manager, Rosie Quiroz,
Licensing Program Analyst and Uldarico "Rico Almiranez, Licensee/Administrator		TIME COMPLETED:
02:35 PM
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An Informal meeting was held via Teams Meeting on this day for the purpose of discussing facility annual visit report conducted on 8/25/2022 in which the annual visit was cut short due to unprofessional behavior of Licensee Rico Alvarez. The following were in attendance: Licensing Program Manager Alisa Ortiz, Licensing Program Analyst Rosie Quiroz and Licensee/Administrator Uldarico “Rico” Almiranez were present.

During the meeting the following was agreed to by Licensee/Administrator:

-Licensee agreed to treat all Departmental Staff with respect during all Community Care Licensing Division (CCLD) related communication.

-Licensee and Department agreed to work collaboratively and amicable.

-Licensee/Administrator agrees to continue to provide appropriate over sight over the facility to maintain compliance with Title 22.

Prior to the meeting Licensee Almiranez sent LPA Quiroz an email apologizing for the interaction.

The exit interview was conducted and a copy of the report was provided via email. Licensee/Administrator agreed to acknowledge receipt of this report via email.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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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