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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005773
Report Date: 11/25/2020
Date Signed: 11/25/2020 11:22:39 AM

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:CSUKARDI, ANITAFACILITY TYPE:
740
ADDRESS:3105 W. ORANGE STREETTELEPHONE:
(714) 229-0069
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:30CENSUS: 13DATE:
11/25/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Anita CsukardiTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Criss Trinidad conducted an announced visit via phone FaceTime virtual technology to Family Choice Senior Living due to the Coronavirus Pandemic and precautionary measures. LPA Trinidad conducted the visit with Administrator Anita Csukardi. The purpose of today's subsequent Pre-Licensing visit was to follow-up on the issues that were present during the last two Pre-Licensing visits.

The following items which were listed in the Pre-licensing visit report have been corrected:


  • Insufficient seating in dining areas
  • Inoperable auditory alarms on exit doors
  • Insufficient seating in outdoor patios
  • Insufficient seating in living room
  • Ensure exit gate is self closing and self latching
  • Complaint poster in correct size 20x26
  • Emergency food supplies
  • Repair and replace inoperable stove top burners
  • Remove excessive black stains surrounding burners
  • Remove excessive black grease stains on oven, door and rack
  • Replace or clean stain in toilet of bathroom 1
  • All renovations to be completed
  • Remove cameras from resident bedrooms
  • Repair or replace inoperable stove top burners
  • Install grab bars for bathroom #1


Component III Orientation points were discussed and completed.

The Pre-Licensing inspection is now complete and this facility is recommended for licensure and Centralized


Application Bureau will be notified.

An exit interview was conducted and a copy of this report was provided to applicant via email. Report to be signed by applicant and returned via email within 24 hours.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Criss TrinidadTELEPHONE: (714) 321-8277
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020
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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