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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005709
Report Date: 02/05/2024
Date Signed: 02/05/2024 04:16:02 PM

Document Has Been Signed on 02/05/2024 04:16 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: 39DATE:
02/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Jordan NguyenTIME COMPLETED:
04:25 PM
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his unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Jordan Nguyen and discussed the purpose of the inspection.

LPA reviewed Infection Control requirements. At about 1:15PM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, and storage areas and observed the following: Structure: facility is a medium complex composed of three buildings containing multiple rooms and bathrooms, common areas, a kitchen, a dining room, a laundry room, a medication room, an office, and multiple storage closets. There is a back yard with a patio cover for the clients. LPA observed 6 staff and multiple clients present at the facility. LPA inspected 22 out of 26 client bedrooms. Client Bedrooms: the 22 client bedrooms inspected are spacious and will easily accommodate the clients’ furnishings. Furniture for 22 client bedrooms inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 116 and 120 degrees F, after corrections. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the storage closets. Medication room: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees have not been paid and are past due. At about 2:15PM, LPA reviewed 6 client files and 6 staff files, interviewed 6 staff and 6 clients, inspected medications for 6 clients, and inspected client money and ledgers for 6 clients.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2024
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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Document Has Been Signed on 02/05/2024 04:16 PM - It Cannot Be Edited


Created By: Sean Haddad On 02/05/2024 at 03:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GENERATIONS OF ANAHEIM ASSISTED LIVING, INC
FACILITY NUMBER: 306005709

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the water temperature in Room 24's bathroom tested at 142 degrees F and 131 in room 16's bathroom, which poses an immediate safety risk to persons in care.
POC Due Date: 02/06/2024
Plan of Correction
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During the inspection, the licensee adjusted the water temperature and LPA confirmed. Licensee stated they will create a water log and limit access to the water heaters to ensure future compliance. POC CLEARED.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Sean Haddad
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/05/2024 04:16 PM - It Cannot Be Edited


Created By: Sean Haddad On 02/05/2024 at 04:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GENERATIONS OF ANAHEIM ASSISTED LIVING, INC
FACILITY NUMBER: 306005709

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80036(a)

80036 Licensing Fees. (a) An applicant or a licensee shall be charged fees as specified in Health and safety Code Section 1523.1. This requirement was not met as evidenced by:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on documents, the licensee did not ensure the facility’s annual fees were paid, which poses a potential risk to persons in care.
POC Due Date: 03/04/2024
Plan of Correction
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Licensee stated they will pay the licensing fees immediately and submit proof to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Sean Haddad
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, INC
FACILITY NUMBER: 306005709
VISIT DATE: 02/05/2024
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During the inspection, LPA and AD observed the following: based on observation, the water temperature in Room 24's bathroom tested at 142 degrees F and 131 in room 16's bathroom; based on documents, the licensee did not ensure the facility’s annual fees were paid.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2024
LIC809 (FAS) - (06/04)
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