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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006419
Report Date: 08/12/2024
Date Signed: 08/12/2024 02:45:58 PM


Document Has Been Signed on 08/12/2024 02:45 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:GOLDEN YEARS GROUP1FACILITY NUMBER:
306006419
ADMINISTRATOR:ATTRAH, AMEERFACILITY TYPE:
740
ADDRESS:2324 E. PURITAN LANETELEPHONE:
(949) 994-2900
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY:6CENSUS: 6DATE:
08/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Ameer A. AttrahTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced Case Management visit in conjunction with a complaint visit 22-AS-20240416125427 on previously owned Licensee. LPA met with Administrator Ameer A. Attrah. LPA explained the reason for the visit.

During the visit LPA observed the following:

Resident #2 and Resident #3 were observed with two 1/2 bed rails to make one full bed rail. Residents are not receiving hospice services and there is no doctor's order on file for the 1/2 bed rails.

In reviewing resident records, facility has not updated their records to show the new License number and New facility name.

LPA noted pool gate door was not secured.

Based on the observations made during today's visit, no deficiency is being cited today. Advisory Notes will be issued. An exit interview was conducted with Administrator Ameer, and a copy of this report was provided at the end of the visit via email.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 705-6004
LICENSING EVALUATOR SIGNATURE:
DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2024
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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