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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005642
Report Date: 11/20/2024
Date Signed: 11/20/2024 01:23:32 PM

Document Has Been Signed on 11/20/2024 01:23 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:CROWN COVEFACILITY NUMBER:
306005642
ADMINISTRATOR/
DIRECTOR:
JANETTE HILLFACILITY TYPE:
740
ADDRESS:3901 EAST COAST HIGHWAYTELEPHONE:
(949) 760-2800
CITY:CORONA DEL MARSTATE: CAZIP CODE:
92625
CAPACITY: 97TOTAL ENROLLED CHILDREN: 0CENSUS: 67DATE:
11/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Janette Hill, Executive Director (ED)TIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by the Concierge at 8:25 AM and met with Resident Care Director (RCD). During today’s visit, LPA met with Janette Hill, Executive Director (ED).

The facility is a three level building with an approved fire clearance of nine ambulatory; eighty-eight non-ambulatory residents of which fifteen are approved for hospice. The facility currently has a census of sixty-seven residents in care. As of July 1, 2024 the community is transitioning to Integral Senior Living and Discovery Senior Living.

During today’s visit, LPA toured the facility with RCD and inspected the physical plant testing hot water temperatures in five of five resident bathrooms, and testing delayed egress on Memory Care exits. Two of three stairwells had evacuation chairs. LPA observed the observation deck and toured both the North and South Towers while visiting resident apartments. The hot water temperatures in resident bathrooms measured between 109.4 and 116.7 degrees Fahrenheit. Smoke detectors were tested by vendor Fire Alarm Systems on April 5, 2023. The Fire Marshall and Maintenance Director are currently working on testing the fire alarms for the past month and is still ongoing. Fire extinguishers were charged and serviced on August 7, 2024. The facility’s last fire drill was conducted by Direct Supply TELS on November 13, 2024 for all three staffing shifts.

LPA inspected the facility kitchen and food supply with Culinary Director and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand with the required emergency water and supplies to accommodate all residents and staff. Food modifications are posted for all line staff to see and temperature logs and cleaning logs were observed.

(Continued on LIC 809-C)
Alisa OrtizTELEPHONE: (714) 287-4084
RoseMarie RuppertTELEPHONE: 714-703-2840
DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CROWN COVE
FACILITY NUMBER: 306005642
VISIT DATE: 11/20/2024
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(Continued from LIC 809)
LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPA toured the Memory Care and observed residents in Activities reading The Daily Chronicle and observed weights in Assisted Living for a fitness class. There is also a resident council meeting scheduled for this afternoon.

LPA reviewed five of five staff training and fingerprint records and reviewed six of six resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on July 13, 2026.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Janette Hill, Executive Director and a copy of the report, LIC 9102-TV and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: RoseMarie RuppertTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC809 (FAS) - (06/04)
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