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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005637
Report Date:
02/24/2023
Date Signed:
02/24/2023 11:09:25 AM
Document Has Been Signed on
02/24/2023 11:09 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:
BLESSINGS SENIOR CARE
FACILITY NUMBER:
306005637
ADMINISTRATOR:
BROWER-GHAHYASI, JENNIFER
FACILITY TYPE:
740
ADDRESS:
724 S. BIRCHLEAF DRIVE
TELEPHONE:
(714) 396-4321
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92804
CAPACITY:
6
CENSUS:
6
DATE:
02/24/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:02 AM
MET WITH:
Aaron Brower
TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a case management visit. LPA was conducting a 10-day complaint visit (#22-AS-20230215094013
) at the facility and observed the following. LPA observed the stove front right burner did not light unassisted and the PUB 475 sign was not by the front door. The sign was moved next to the front door during the visit. The PUB 475 sign is the correct size. Licensee Aaron Brower was present during the visit. Staff reported that the front right burner is not used. No other deficiencies observed during the visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
02/24/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/24/2023
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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