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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006130
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:20:22 PM

Document Has Been Signed on 10/24/2023 03:20 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:CK HOMES / NEPTUNE DRIVEFACILITY NUMBER:
306006130
ADMINISTRATOR:FESTIN, ALEXANDERFACILITY TYPE:
740
ADDRESS:8455 NEPTUNE DRIVETELEPHONE:
(714) 527-6009
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 3DATE:
10/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Olivette CrisostomoTIME COMPLETED:
03:35 PM
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This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of a health and safety check and to follow up on an incident reported verbally to LPA by Administrator (AD) Maxine Kniazeff on 10/24/23 regarding Resident #1 (R1). LPA met with Staff #1 (S1) Olivette Crisostomo and discussed the purpose of the inspection. AD appeared via telephone.

During today’s inspection, LPA toured the facility with S1 and observed 1 staff and 2 residents present. LPA conducted health and safety checks on the residents present and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food, the electricity and water were running, and the medications and sharps were properly stored. LPA interviewed AD and requested and reviewed copies of the resident roster and staff roster. AD stated they will email LPA copies of the incident report once it is complete as well as R1’s resident file.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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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