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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005709
Report Date: 05/22/2023
Date Signed: 05/22/2023 02:06:57 PM

Document Has Been Signed on 05/22/2023 02:06 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 & INLAND A/SC, 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: 38DATE:
05/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Kyle Watanabe, Interim Administrator
Theresa Pacleb, Maintenance supervisor		TIME COMPLETED:
02:30 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced case management visit for the purpose of documenting and citing deficiencies observed during the investigation of complaint number 22-AS-20230517161013.

During the visit, LPA accompanied by Administrator and Maintenance/Housekeeping supervisor Theresa Pacleb toured or attempted to tour all 26 units in the facility. During the visit, multiple shared bathrooms were observed to be visibly dirty, with traces on the floor, soap scum in the showers and overflowing garbage pails. Toilet paper soiled with fecal matter were also observed in the trash bins next to the commodes in multiple locations. A similar deficiency was already Substantiated during the investigation of prior complaint referenced 22-AS-20220812154909 and cited accordingly as a type A violation on August 19, 2022. Photographs were taken during the visit.

A similar type A citation for violation of Section 80087 of the California Code of Regulations on Buildings and Grounds (a) is being issued during the visit.

A Technical Assistance Advisory Note on maintaining accurate staff association status in Guardian is also provided to facility representative.

An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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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Document Has Been Signed on 05/22/2023 02:06 PM - It Cannot Be Edited


Created By: Kevin Saborit-Guasch On 05/22/2023 at 01:32 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: 05/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2023
Section Cited
CCR
80087(a)

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The California Code of Regulations Section 80087(a) on Buildings and Grounds states that: "The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients."

This requirement is not met as evidence by:
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Licensee is to update staff training and instruct clients to flush soiled toilet paper rather than put it in open trash bins in the shared bathrooms before the Plan of Correction's due date.
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Based on observations conducted, clients are still storing used toilet paper visibly soiled with fecal matter in an unsanitary manner which poses an immediate risk to the Health, Safety and Personal Righs of the individuals in care.
REPEAT VIOLATION/CIVIL PENALTY ASSESSED.
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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:Sheila Santos
LICENSING EVALUATOR NAME:Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023


LIC809 (FAS) - (06/04)
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