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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005709
Report Date: 06/15/2022
Date Signed: 06/15/2022 04:25:38 PM

Document Has Been Signed on 06/15/2022 04:25 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:
06/15/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Melina Alonzo
Maria Nonato		TIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Claudia Gutierrez and Lydia Martinez made an unannounced visit to follow-up on a case management visit dated 6/14/2022. LPAs met with Office Manager (OM) Maria Nonato and Medication Supervisor (MS) Melina Alonzo. LPAs observed three staff physically present at the facility, including MS, OM, and cook. Staff stated they are currently shorthanded, and that MS is also acting as Care Staff and Activities director, with a vendor coming in to do activities once a month. LPAs and MS took a tour of the facility and observed it to be under construction. MS stated the facility has been under construction since 5/9/2022. LPAs observed power and construction tools laying unattended in the back central building. LPA Gutierrez inquired about health and safety checks to which MS stated rounds and checks are done. LPA Martinez reminded staff that all tools must be made inaccessible when not in use.

MS and OM contacted Administrated (AD) Diosdado Manqune by phone. LPA Gutierrez spoke with AD over facetime. LPA Gutierrez inquired about permits related to the construction taking place, AD stated no permits have been obtained. Facility was unable to provide LPAs with any proof that Community Care Licensing Division (CCLD) was notified of any construction taking place at the facility.

Facility was able to provide LPAs with an LIC500. Upon record review LPA Gutierrez confirmed medications documents are logged and centrally kept.

There were two deficiencies cited by Title 22 Division 6 of the California code of regulations. An exit interview was conducted and a 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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Document Has Been Signed on 06/17/2022 12:01 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/17/2022 09:55 AM


Created By: Claudia Gutierrez On 06/15/2022 at 03:27 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
CCLD Regional Office, 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: 06/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2022
Section Cited
CCR
80086(a)

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Alterations to Existing Building or New Facilities
Prior to construction or alterations, all licensees shall notify the licensing agency of the proposed change.

This requirement is not being met as
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Adminstrator stated they will provide LPA Gutierrez with an updated facility sketch, plans of ongoing construction, a date of when construction is expected to conclude, and permits by POC date 6/16/22 via email.
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evidence by LPAs observed construction that is not consistant with current floor plan and fire clearance.This poses an immediate health and safety risk to clients in care.
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Type A
06/15/2022
Section Cited
CCR80087(a)

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Buildings and Grounds
The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not being met as evidence by LPAs observed power and
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Office Manager and Medication Supervisor stated they will make the tools inaccessible to clients by placing tools in a secluded area. Office Manager will provide LPA with picture proof of inaccessible power tools via email by 6/16/22.
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construction tools left unattended in the central back building. This posses an immediate health and safety risk to clients in care.
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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:Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022


LIC809 (FAS) - (06/04)
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