<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005934
Report Date: 04/28/2022
Date Signed: 04/28/2022 05:47:54 PM


Document Has Been Signed on 04/28/2022 05:47 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:ADULT CARE OC SATURNAFACILITY NUMBER:
306005934
ADMINISTRATOR:SCHOTT, BRIANFACILITY TYPE:
740
ADDRESS:24591 SATURNA DRIVETELEPHONE:
(626) 861-1124
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
04/28/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:39 PM
MET WITH:Administrators (ADs) Brian Schott and Fe SzalonekTIME COMPLETED:
06:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility. LPA met with Administrator (ADs) Brian Schott and Fe Szalonek; and stated the purpose of this visit.

On April 25, 2022, Community Care Licensing Division (CCLD) Orange office received a phone call from Administrator (AD) Fe Szalonek. AD informed CCLD about a recent infection outbreak in the facility. LPA Marin provided guidance and sent an email to AD Szalonek and AD Schott for information needed.

For this visit, LPA toured the interior and exterior portions of the facility. LPA reviewed the COVID 19 mitigation of the facility; and provided technical assistance on the outbreak.

No citation was issued on this visit.

LPA Marin conducted an exit interview with AD Brian Schott / AD Fe Szalonek. Copy of this report, was left in the facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1