306006018-6-14-2024-22-AS-ARJR-D68V6Q-20240614160951

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006018
Report Date: 06/14/2024
Date Signed: 06/14/2024 04:09:59 PM

Document Has Been Signed on 06/14/2024 04:09 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	CRESCENT LANDING AT SOUTH COAST MEMORY CARE		FACILITY NUMBER:	306006018
ADMINISTRATOR:	TORRES, JUDITH		FACILITY TYPE:	740
ADDRESS:	3730 S. GREENVILLE AVENUE		TELEPHONE:	(419) 247-2800
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	72	CENSUS: 45	DATE:	06/14/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:39 PM
MET WITH:	Judith Torres-Administrator		TIME COMPLETED:	04:25 PM

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Administrator (AD) Judith Torres.

For today’s visit, LPA observed a total of 45 residents in care.

LPA observed the Administrator's Certificate for facility AD Judith Torres which expires on July, 15 2024.

LPA Ramirez toured the interior and exterior portions of the facility with AD Torres. Facility is a 2-building complex with a single story in each building. The building complex in the front is being used as staff offices.

The complex building in the back is the Memory Care and has 36 bedrooms with each bedroom having its own bathroom, and additional common bathrooms. LPA Ramirez observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. LPA observed bathrooms to have hand washing signs posted. Water temperature tested between 107.8-109.4 degrees Fahrenheit.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers were charged and mounted.

LPA Ramirez observed the emergency disaster and evacuation plans, one is located by the front desk lobby and one in the Medication room.

CONTINUED ON LIC9099-C...

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CRESCENT LANDING AT SOUTH COAST MEMORY CARE	FACILITY NUMBER: 306006018
	VISIT DATE: 06/14/2024

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Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care.

For the exterior portion, LPA Ramirez observed a shaded patio area with furniture, and observed that the grounds were free of any hazards.

During today's visit LPA observed that the residents were participating in the entertainment activity. The entertainment activity consisted of singing and dancing.

LPA reviewed five resident files and four staff files. LPA interviewed residents and staff present.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Torres.

A copy of this report was provided at the time of exit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024

LIC809 (FAS) - (06/04)

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