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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005926
Report Date: 03/23/2022
Date Signed: 03/23/2022 08:34:01 PM


Document Has Been Signed on 03/23/2022 08:34 PM - 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:CRESCENT CARE VILLAS - LEMON HEIGHTSFACILITY NUMBER:
306005926
ADMINISTRATOR:ALI, AWABFACILITY TYPE:
740
ADDRESS:11541 HIGHLAND LNTELEPHONE:
(949) 441-0810
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:6CENSUS: 1DATE:
03/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Barenka Cano and Rizwan YuraizeeTIME COMPLETED:
01:45 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 Caregiver Barenka Cano and Director Rizwan Yuraizee. Administrator Awab Ali was contacted. He was not able to come to the facility. The focus of the visit was Infection Control. The facility was toured with Ms. Barenka and the following was observed:
Covid signs were posted in the facility and a sanitization station was set up near the front entrance. LPA's temperature was taken upon arrival and a sign in sheet was available. Facility has required Department postings. Restrooms observed contained soap and toilet paper and paper towels. 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. There was 1 resident present watching tv in the living room and speaking to family on the phone. Administrator Certificate for Awab Ali expires 8/23/22. LPA noted on today's visit that the facility Licensing fees have not been paid and that Mr. Ali is the only staff associated to the facility. Mr. Ali is reminded that he must pay the annual fees and use the Guardian System to associate staff or civil penalties will be assessed. Social Distancing and masks were observed. Licensee has required Mitigation plan and Emergency Disaster Plan. Facility has emergency food and water supply. Facility has a secured medication cupboard for resident medication and files.

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 mask wearing and hand washing for staff, visitors. Administrator is reminded to review Department PINS in regards to Masking, Staff and Resident Testing, Visitation, Dining, Group Activities, Non-essential services, Outings, New Admissions and Entertainment. No deficiencies noted during visit. An exit interview was conducted and a copy of this report was provided to Rizwan Yuraizee.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022
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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