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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005546
Report Date: 06/15/2023
Date Signed: 06/15/2023 04:47:27 PM


Document Has Been Signed on 06/15/2023 04:47 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:REATA GLEN ORANGE COUNTY CCRC LLCFACILITY NUMBER:
306005546
ADMINISTRATOR:NASRATY, SUZANNEFACILITY TYPE:
741
ADDRESS:2 LAS ESTRELLAS LOOPTELEPHONE:
(949) 545-2250
CITY:RANCHO MISSION VIEJOSTATE: CAZIP CODE:
92694
CAPACITY:840CENSUS: DATE:
06/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Marirose KendleTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility to conduct a Case Management - Incident to follow up on information regarding on a Resident's death. LPA met with Resident Health Services Director (RHSD) Marirose Kendle, Safety Director, Joe Parrett, and Kelly Conk, Associate Executive Director and explained the nature of the visit.

During LPA's visit, LPA toured the Men's locker room, Steam Room and Pool area, reviewed and obtained copies of pertinent documentation and conducted interviews regarding the death of Resident 1 (R1) who passed away on 06/09/2023. LPA spoke to Directors to get further information regarding the death of R1 and the events that led up to R1's death. RHSD Kendle stated the official Death Report has been not been sent to CCLD at this time, as she is awaiting for additional information from the family. Facility does not know if an autopsy will be performed.

There was no preliminary cause of death that was determined or provided. LPA advised RHSD Kendle to send a copy of the Death Report to the department as soon as it is completed.

No deficiencies were cited during this visit.

An exit interview was conducted and a copy of this report (LIC809) and LIC811 (Confidential Names) will be sent to email on file.

SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
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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