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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006018
Report Date: 10/27/2023
Date Signed: 10/27/2023 04:43:52 PM


Document Has Been Signed on 10/27/2023 04:43 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 LANDING AT SANTA ANA MEMORY CAREFACILITY NUMBER:
306006018
ADMINISTRATOR:TORRES, JUDITHFACILITY TYPE:
740
ADDRESS:3730 S. GREENVILLE AVENUETELEPHONE:
(419) 247-2800
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:72CENSUS: 50DATE:
10/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Judith Torres- Executive DirectorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to continue the investigation in connection to Complaint Control Number: 22-AS-20201109104853 filed against the former licensee who was operating at this location. LPA met with Executive Director (ED) Judith Torres and explained the reason for the visit.

On today's date, LPA interviewed Staff #1 (S1) pertaining to Resident #1 (R1) and obtained copies of previous staff attendance records. ED stated that they will submit dates involving Staff #2 (S2) as discussed during the interview. This will be due on Monday, October 30, 2023 by close of business.

An exit interview was conducted with Executive Director Judith Torres, and a copy of this report including the LIC811s were provided at the end of the visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023
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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