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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005505
Report Date: 07/08/2022
Date Signed: 07/08/2022 11:26:47 AM


Document Has Been Signed on 07/08/2022 11:26 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:SELECT SENIOR CARE LLCFACILITY NUMBER:
306005505
ADMINISTRATOR:DATCU, DANIELFACILITY TYPE:
740
ADDRESS:1221 N BIG SPRING STTELEPHONE:
(714) 695-9370
CITY:ANAHEIMSTATE: CAZIP CODE:
92807
CAPACITY:6CENSUS: 6DATE:
07/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Daniel Dactu and TIME COMPLETED:
11:25 AM
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Licensing Program Analyst MIchelle Reed arrived at the facility to conduct a case management visit. The visit was conducted to discuss an unusual incident report that was sent to the Licensing office on 6/28/22. Upon arrival, LPA met with Licensee Daniel Dactu and Carmen Daraban.

On 6/27/22 R1 was visited by his Daughter. The visit was conducted outside due to Covid precautions. R1's Daughter took R1 from the facility and told staff that she would be back after dinner. When R1 was not returned to the facility, Mr. Dactu contacted R1's POA. The POA stated that the Daughter would be keeping R1 overnight in San Diego. Mr. Dactu notified the POA that R1 did not have any medications. R1 missed his evening and morning medications.

R1's Daughter took him to the hospital on 6/27/22 for a skin tear and he was returned the next day to the facility by the POA.

Based upon inteviews and a review of records, no Title 22 regulations were violated.

An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2022
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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