306005806-8-19-2020-22-AS-PVEZ-BSMME6-20200819093214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005806
Report Date: 08/19/2020
Date Signed: 08/19/2020 09:32:21 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:	WE CARE SENIOR LIVING		FACILITY NUMBER:	306005806
ADMINISTRATOR:	SANSANO, CHERRYL		FACILITY TYPE:	740
ADDRESS:	24322 BARK ST		TELEPHONE:	(949) 446-9841
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	6	CENSUS: 5	DATE:	08/19/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Cheryl Sansano - Administrator		TIME COMPLETED:	09:30 AM

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Licensing Program Analysts (LPAs) Patricia Velazquez and Criss Trinidad conducted an announced subsequent Pre-Licensing visit via phone FaceTime virtual technology to We Care Senior Living due to the Coronavirus Pandemic and precautionary measures. LPAs Velazquez and Trinidad conducted the visit with Administrator Cheryl Sansano. The purpose of today's subsequent Pre-Licensing visit was to follow-up on the issues that were present during the initial Pre-Licensing visit dated 08/14/2020. The following issues were observed and required correction:

Repair or replace the inoperable dishwasher
Remove all the items in the side yard such as table, weed killer, plastic bin storing cans of paint, broom, lawn mower, desk, mattresses, lamp, and cart
Repair the latch on the exit gate that is not self-latching
Obtain mattress pads for resident beds
Replace torn mattress cover on one resident bed
Obtain a shower curtain for one resident bathroom
Obtain 2 chairs for dining table to accommodate all residents
Obtain 2 chairs for the exterior seating area to accommodate all residents
Obtain 1 chair in the living area to accommodate all residents
Securely lock all cleaning supplies

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (714) 380-0440
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WE CARE SENIOR LIVING	FACILITY NUMBER: 306005806
	VISIT DATE: 08/19/2020

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On today's FaceTime phone visit the aforementioned items have been addressed and corrected. The items reviewed during this visit are in compliance. The Pre-Licensing is complete and the facility appears ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau.

An exit phone interview was conducted with Administrator Cheryl Sansano and a copy of this report was signed by LPA Patricia Velazquez. This report will be sent via email to Ms. Cheryl Sansano who agrees to sign and date the report. This report was sent via email and an electronic read receipt confirms receiving the report. Ms. Sansano agrees to send the original report by mail to the CCLD Regional Office (RO) in Orange. LPA Velazquez provided the RO address to Administrator Cheryl Sansano.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (714) 380-0440
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020

LIC809 (FAS) - (06/04)

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