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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006185
Report Date: 11/18/2022
Date Signed: 11/18/2022 01:02:39 PM


Document Has Been Signed on 11/18/2022 01:02 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:EUROPEAN RETIREMENT LIVING LLC IFACILITY NUMBER:
306006185
ADMINISTRATOR:TATARICI, FLORELA GABRIELAFACILITY TYPE:
740
ADDRESS:10182 EDYE DR.TELEPHONE:
(949) 394-5764
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY:6CENSUS: 6DATE:
11/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Administrator, Gaby TatariciTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a single story residential home. LPA along with Administrator Gaby Tatarici toured facility.

Fire clearance approval was received on 05/18/22. Structure: Facility is a one story, 7 bedroom (6 Residents bedrooms and 1 live in staff bedroom) 5 bathroom house with detached garage and a white exterior. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements and have required furnishings such as Bed, nightstand, drawer, chair, lamps and calling systems. Bathrooms: All resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as emergency food and water supply. Facility has three fridges. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Fire extinguisher is mounted and charged. Facility has 1 extinguisher. Facility has audible alarms on all sliding/exit doors. Appliances: Electric Stove and refrigerator are operational. Toxins: LPA observed toxins secured in laundry storage area.. Water Temperature: Tested and recorded between 102.3 to 116.1 degrees F. in facility bathrooms. Reading Material Games, and Equipment:
facility does games, puzzles and newspapers. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on one side of facility as required. LPA observed shaded outdoor seating.

CONTINUED ON 809C
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: EUROPEAN RETIREMENT LIVING LLC I
FACILITY NUMBER: 306006185
VISIT DATE: 11/18/2022
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Administrator's Certificate observed on wall expiring August 1, 2024.

Component III Orientation was waived during this pre-licensing visit due to Administrator presently operating several facilities.

Facility has Publication 475 Posted however Administrator was advised to enlarge poster to 20x26 size. Administrator to provide proof of change to LPA.

No deficiencies noted during todays visit. The pre-licensing visit has been completed. This location is ready for licensure.


An exit interview was conducted with Administrator and a copy of report was left at facility
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC809 (FAS) - (06/04)
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