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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005709
Report Date: 06/14/2022
Date Signed: 06/15/2022 04:23:10 PM

Document Has Been Signed on 06/15/2022 04:23 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GENERATIONS OF ANAHEIM ASSISTED LIVING, INCFACILITY NUMBER:
306005709
ADMINISTRATOR:MANALAD, JOSELITOFACILITY TYPE:
735
ADDRESS:1941 E. CENTER STREETTELEPHONE:
(714) 533-3640
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 42CENSUS: 40DATE:
06/14/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Melina Alonzo
Maria Nonato		TIME COMPLETED:
12:40 PM
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 This is an amended report.

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit. LPA Gutierrez met with Office Manager Maria Nonato and Medication Supervisor Melina Alonzo. The purpose of today's Case Management visit is to follow-up on a Death Report received on 6/13/2022, regarding Client 1 (C1). C1’s death report was dated 6/9/2022.

LPA Gutierrez conducted a tour of the facility and C1's bedroom. Some bedrooms were observed to have freshly painted walls and sleek wood floors. Other bedrooms were observed to have stained walls and uneven flooring. Kitchen was observed to have a 2-day supply perishable and a 7-day supply of non-perishable food. LPA Gutierrez received Client 1’s file. LPA will return documentation within 3 days. LPA requested staff schedule and LIC 500 to which Maria Nonato stated they were not available and would email to LPA by end of day.

An exit interview was conducted and copy of this report was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2022
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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