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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006011
Report Date: 03/07/2024
Date Signed: 03/07/2024 03:55:47 PM

Document Has Been Signed on 03/07/2024 03:55 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:VIRTUD CARE LLCFACILITY NUMBER:
306006011
ADMINISTRATOR:SANCHEZ, GEISEL DAGNEFACILITY TYPE:
740
ADDRESS:13092 NEWLAND STTELEPHONE:
(714) 583-8441
CITY:GARDEN GROVESTATE: CAZIP CODE:
92844
CAPACITY: 6CENSUS: 7DATE:
03/07/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Geisel Sanchez, Licensee/AdministratorTIME COMPLETED:
04:05 PM
NARRATIVE
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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit in conjunction to a 10 day inspection visit for complaint control #22-AS-20240305154314.

LPA Quiroz was greeted and granted entry into the facility by Licensee/Administrator (L/AD) Geisel Sanchez and explained the reason for the visit.

During today's visit, LPA Quiroz along with (L/AD) Sanchez conducted a tour of the interior and exterior of facility premises. While conducting facility tour, LPA Quiroz observed 7 residents in care. (SEE LIC 809-D)

The Facility is licensed to operate a Residential Care Facility for the Elderly, age range 60 and over. Fire Clearance for five (5) non-ambulatory residents and one (1) bedridden resident in room #1 and has a hospice waiver approved for six (6) residents.

The facility is being cited per Title 22, Division 6 of the California Code of Regulations. Civil penalty assessed during today's visit. (SEE LIC 421-IM)

An exit interview was conducted with (L/AD) Sanchez, and a copy of this report, 809-D Page, Civil Penalty, and Appeal Rights were provided at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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Document Has Been Signed on 03/07/2024 03:55 PM - It Cannot Be Edited


Created By: Rosie Quiroz On 03/07/2024 at 03:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VIRTUD CARE LLC
FACILITY NUMBER: 306006011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/08/2024
Section Cited
CCR
87204(a)

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87204(a)Limitations - Capacity and Ambulatory Status(a)A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons...This requirement is not being met as evidenced by: CONT
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(L/AD) Sanchez relocated R1 to Sister Facility VIRTUD CARE LLC II #306006211 at 12:00pm. Corrected during today's visit. Civil penalty assessed during today's visit.
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During today's inspection visit, LPA Quiroz observed 7 residents in care. The facility iis licensed for a capacity of 6 residents Fire Clearance for five (5) non-ambulatory residents and one (1) bedridden resident in room #1 and has a hospice waiver approved for six (6) residents.
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This poses an immediate risk for residents in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alisa Ortiz
LICENSING EVALUATOR NAME:Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


LIC809 (FAS) - (06/04)
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