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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005871
Report Date: 12/16/2021
Date Signed: 12/16/2021 01:15:37 PM

COMPREHENSIVE INSPECTION
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:HILLCREST SENIOR LIVINGFACILITY NUMBER:
306005871
ADMINISTRATOR:ALVARADO, MARY JEANFACILITY TYPE:
740
ADDRESS:6468 CALLE DEL NORTETELEPHONE:
(714) 749-7237
CITY:ANAHEIM HILLSSTATE: CAZIP CODE:
92807
CAPACITY:6CENSUS: 6DATE:
12/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Eduardo Capistrano and Mary Jean AlvaradoTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Michelle Reed made an unannounced visit to the facility to conduct an Annual visit. Upon arrival LPA met with Staff Eppie Santiago Ruby a. Mr. Capistrano is the husband of Mary Jean Alvarado. The focus of the visit was Infection Control. Mary Jean arrived at approximately 1pm. LPA toured the facility with Mr. Capistrano and the following was observed:
Covid signs were posted at the front entrance of facility with a sanitization station. There is currently 1 entrance in and out of the facility. LPA's temperature was taken upon arrival and a sign in sheet was available. Facility has required Department postings. Administrator Certificate for Eduardo Capistrano expires 5/3/23 and 6/8/22. Restrooms observed contained soap, paper towels and toilet paper. Hand sanitizer, soap, wipes and gloves were present and in sufficient supply. The Licensee has at least a 30 day supply of PPE. LPA observed an outside visitation area with ample shading. Six residents were present. Social distancing and masks for staff were observed. Licensee has required Mitigation plan and Emergency Disaster Plan. Facility has emergency food and water supply. Facility has a secured storage for medication and files. All residents have at least a 30 day supply of medications. All staff and residents vaccinated and have had their booster shots.
During the visit, LPA consulted with staff regarding the importance of maintaining a 30 day supply of PPE on site. Additionally, LPA advised the importance of masks and handwashing for staff. Administrator is reminded to review all PINS for updated Covid information as well as procedures for Visitation, Dining, Group Activities, Non-essential services, Outings, New Admissions and Entertainment. Facility Staff Testing and Masking Guidelines are also included in PINS.
No deficiencies noted during visit. An exit interview was conducted and a copy of this report was provided to Mr. Capistrano.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
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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