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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005773
Report Date: 05/16/2023
Date Signed: 05/16/2023 11:37:14 AM


Document Has Been Signed on 05/16/2023 11:37 AM - 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:FAMILY CHOICE SENIOR LIVINGFACILITY NUMBER:
306005773
ADMINISTRATOR:JUNGE, PAMELAFACILITY TYPE:
740
ADDRESS:3105 W. ORANGE STREETTELEPHONE:
(714) 229-0069
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:30CENSUS: 13DATE:
05/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Pamela Junge- Administrator TIME COMPLETED:
09:00 AM
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On this day Licensing Program Analysts (LPAs) Andrea Mendivil and Kimberly Lyman made an unannounced visit to conduct a Plan of Corrections (POC) based upon the deficiencies cited in LIC form 809D on 05/08/2023. LPAs were greeted and granted entry into the facility by Administrator Pamela Junge.

*Deficiency cited under Title 22 Regulation 87555 (b) (8) pertaining to food that was not in good quality has been cleared. The food that was not in good quality was removed from the refrigerator and new 2 day perishables were in the refrigerator.

*Deficiency cited under Title 22 Regulation 87211 (a) (1) (D) pertaining to lack of construction plans in the kitchen. The plans for kitchen construction have been reviewed.

No deficiencies cited, an exit was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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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