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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006247
Report Date: 12/18/2024
Date Signed: 12/18/2024 03:47:32 PM

Document Has Been Signed on 12/18/2024 03:47 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:FAMILY CHOICE SENIOR LIVINGFACILITY NUMBER:
306006247
ADMINISTRATOR/
DIRECTOR:		JUNGE, PAMELAFACILITY TYPE:
740
ADDRESS:3105 W. ORANGE AVENUETELEPHONE:
(714) 229-0069
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 30CENSUS: 23DATE:
12/18/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:53 PM
MET WITH:Pamela Junge - AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:03 PM
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On 12/18/2024, LPA Dwayne Mason Jr arrived at the facility for the purpose of conducting a plan of corrections visit. LPA arrived and was greeted and granted entry by staff. LPA explained the purpose of the visit.

The facility received three deficiencies as part of an annual inspection and a complaint investigation both conducted on 11/22/2024 under the following Title 22 Regulations: 87303(a), 87465(c)(2) and 87211(a)(1)(D).

Regarding the 87303(a) citation: LPA observed the fence to be repaired and made inaccessible to residents in care.

Regarding the 87465(c)(2) citation: LPA received an email on 12/9/2024 containing the requested documentation for a medication in-service training conducted on 12/5/24.

Regarding the 87211(a)(1)(D) citation: LPA received an email on 12/9/2024 containing the requested documentation for a reporting requirement in-service training conducted on 12/6/24.

Based on today's visit, the LPA determined all plans of correction were fulfilled by the assigned POC due dates. LPA reviewed this report with facility staff and provided a copy.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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