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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005773
Report Date:
06/14/2023
Date Signed:
06/14/2023 09:40:46 AM
Document Has Been Signed on
06/14/2023 09:40 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 LIVING
FACILITY NUMBER:
306005773
ADMINISTRATOR:
JUNGE, PAMELA
FACILITY TYPE:
740
ADDRESS:
3105 W. ORANGE STREET
TELEPHONE:
(714) 229-0069
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92804
CAPACITY:
30
CENSUS:
12
DATE:
06/14/2023
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
08:33 AM
MET WITH:
Lily Ramos
TIME COMPLETED:
09:58 AM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on citations issued on 05/16/2023. LPA was greeted and granted entry into the facility and explained the reason for the visit.
*Deficiency cited under Title 22 Regulation 87464(f)(1) pertaining to Basic Services has been cleared. LPA observed hygiene items present at the facility. Licensee has complied with the POC.
*Deficiency cited under Health and Safety Code 1569.269(a)(8)
pertaining to Personal Rights has been cleared. LPA observed unsecured drinking water. Licensee has complied with the POC.
*Deficiency cited under Title 22 Regulation 87405(a)(1) pertaining to Administrator Qualifications has been cleared. Licensee submitted correction timely. Licensee has complied with the POC.
*Deficiency cited under Title 22 Regulation 87535(b)(3) pertaining to Food Services has been cleared. Licensee submitted correction timely and LPA observed snacks at the facility. Licensee has complied with the POC.
Licensee has been advised to maintain compliance in all items previously cited.
Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME:
Alisa Ortiz
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Kimberly Lyman
TELEPHONE:
(714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE:
06/14/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/14/2023
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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