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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005612
Report Date: 09/18/2024
Date Signed: 09/18/2024 12:11:24 PM


Document Has Been Signed on 09/18/2024 12:11 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:LAKEVIEW ELDERLY CAREFACILITY NUMBER:
306005612
ADMINISTRATOR:VESA, SILVIUFACILITY TYPE:
740
ADDRESS:4355 E ELKSTONE AVETELEPHONE:
(714) 974-5660
CITY:ANAHEIMSTATE: CAZIP CODE:
92807
CAPACITY:6CENSUS: 5DATE:
09/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Florela G Taricitatarici TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Joseph Alejandre and William Vanegas made an unannounced visit to conduct the required annual inspection. LPAs were greeted and granted entry by staff. LPAs met with Administrator Florela Tarictatarici and explained the reason for the visit. The facility is a one story home with 6 resident rooms, 2 staff rooms, 4 bathrooms, living room with a screened fireplace, kitchen, dining room, family room and a two car garage which is not accessible from inside the house. LPAs observed the See Something, Say Something poster (PUB 475) measured 12 1/2 by 21 inches. LPAs and the Administrator toured the facility. LPAs observed all resident rooms had the required furnishings and bedding. The smoke detectors and carbon monoxide detectors tested operational. LPAs observed the kitchen is clean and organized. There is a two perishable and a 7 day non-perishable food supply on hand in the kitchen. Knives are kept locked in a kitchen drawer. The fire extinguisher in the kitchen is fully charged. Cleaning supplies are kept locked in the laundry room. The 5 burner gas stove lights unassisted. LPAs observed all 4 bathrooms are clean and operational. Hot water measured 120.8 degrees Fahrenheit. The last emergency drill was conducted on July 1, 2024. LPAs inspected the first aid kit. The first aid kit has all the required elements. LPAs and Administrator toured the backyard. No bodies of water observed. There is a shaded patio with tables and chairs for residents to sit outside. Both exit gates on each side of the house are operational. No obstacles or hazards observed inside or outside of the facility. LPAs reviewed 3 staff files. All staff are background cleared and associated to the facility. All 3 staff had the required training. LPAs reviewed 6 resident files. No discrepancies observed. LPA reviewed resident medications, no discrepancies observed. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
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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