<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005726
Report Date: 06/23/2021
Date Signed: 06/23/2021 04:03:14 PM

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:TRADITIONS AT STACEY LEEFACILITY NUMBER:
306005726
ADMINISTRATOR:DE LOS REYES, LORDELEFACILITY TYPE:
740
ADDRESS:5105 EAST STACEY LEE LANETELEPHONE:
(714) 769-5858
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY:6CENSUS: 6DATE:
06/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:16 PM
MET WITH:Manuel De Los ReyesTIME COMPLETED:
04:17 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted at the door by caregiver and granted entry. LPA explained the nature of the visit to the caregiver. Administrator arrived shortly after and met with LPA.

LPA began the tour of the facility accompanied by caregiver. The facility currently has 6 residents in care. LPA observed three residents in living room watching tv. All residents appeared happy and well taken care of. Facility was clean and sanitary. Facility staff screens all visitors to the facility upon entry and a log is kept with information. Facility keeps documentation/logs in regard to covid for all residents, visitors, and staff. At 2:50pm LPA tested the hot water temperature in bathroom which is used by residents. The hot water temperature was measured at 115.8 Fahrenheit degrees. LPA observed facility has covid precautionary postings through out the facility as well as all Department required postings. Facility has an active covid-19 prevention plan in place for the safety of residents in care. LPA observed ample supply of food and water as well as fist aid kits in the facility. Facility has an ample supply of PPE, incontinence, and cleaning supplies. Facility has sanitation precaution in place through out the facility and all common spaces. Facility has hand sanitizer stations mounted on the wall all through the facility. LPA toured the outside of the facility and observed there is a shaded seating area for residents along with sanitizing needs. Area is also used for outdoor visitations. Facility has a plan for covid testing staff and residents as needed as well as a plan for isolation as needed. Facility bedrooms are four private and one shared bedroom.

Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrator and a copy of this report was provided and left at facility.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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 1