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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005773
Report Date: 09/10/2021
Date Signed: 09/10/2021 10:57:33 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:REHBEIN, ERINFACILITY TYPE:
740
ADDRESS:3105 W. ORANGE STREETTELEPHONE:
(714) 229-0069
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:30CENSUS: 8DATE:
09/10/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Erin RehbeinTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced health and safety visit to the facility to follow up on prior staffing issues in the facility. LPA was greeted and granted entry into the facility by Administrator Erin Rehbein and explained the reason for the visit. There are two caregivers present as well as Administrator Rehbein during today's visit.

During the visit, LPA toured the facility and spoke with residents. Facility appears clean and sanitary. Residents are relaxing in the common area or in their rooms. LPA spoke with Administrator regarding staffing concerns. Administrator indicates hiring three more caregivers in the last week and utilizing staffing agencies as needed. LPA reviewed the staff schedule for the next two weeks and two staff are scheduled for every shift.




No health and safety concerns noted during today's visit.

No deficiencies noted during today's visit.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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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