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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005773
Report Date: 05/31/2023
Date Signed: 05/31/2023 03:22:51 PM


Document Has Been Signed on 05/31/2023 03:22 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: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: DATE:
05/31/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Shahzad Khan and Pamela JungTIME COMPLETED:
03:30 PM



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An Informal Conference was held on this date at the Orange County Adult and Senior Care Regional Office, in Orange, California. The informal meeting process was explained to the Licensee.

At this informal conference, present were: Licensing Program Manager (LPM) Alisa Ortiz, Licensing Program Analyst Kimberly Lyman, Licensee Shahzad Khan and Administrator Pamela Jung. Principal Adam Bhaijee was present via telephone. The purpose of the meeting was to discuss a series of deficiencies issued in the last month and the health and safety of residents in care during the change of ownership.

The following Concerns were discussed during the meeting:

  • Maintaining an adequate supply of perishable and non-perishable food supply in good condition.
  • Maintaining an accessible supply of hygiene items for staff as well as best practices for accessibility and infection control.
  • Process for updating the plan of operation.
  • Ensuring accessibility of emergency supplies.
  • Ensuring a work environment free from retaliation for residents, staff, and outside agencies.


Licensee agrees to ensuring the above items are in place at the facility.

Exit interview conducted and a copy of this report was provided to Licensee.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
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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