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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006425
Report Date: 01/30/2024
Date Signed: 01/30/2024 11:26:03 AM

Document Has Been Signed on 01/30/2024 11:26 AM - 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:LEISURE WORLD SEAL BEACH LWSB MEMORY CONNECTIONFACILITY NUMBER:
306006425
ADMINISTRATOR:MCALEER, JAMESFACILITY TYPE:
775
ADDRESS:1661 GOLDEN RAIN RD CLUBHOUSE6TELEPHONE:
(949) 757-3760
CITY:SEAL BEACHSTATE: CAZIP CODE:
90740
CAPACITY: 15CENSUS: 0DATE:
01/30/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gayle EhrenbergTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Gayle Ehrenberg, discussed the purpose of the inspection, and toured the facility. Facility is to operate an Adult Day Program. Application was submitted to Community Care Licensing on 09/13/2023. This is an initial application with no clients in care.
During the inspection, LPA and AP observed the following: Structure: this is a two-story commercial building which is used by the community as an activity center. The facility occupies two rooms on the second floor: the classroom and the office, both of which are on the northwest corner. The facility shares the bathrooms with the rest of the building. There is no outdoor area. Facility telephone number is (949) 293-7326. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 127 F degrees in the bathrooms closest to the facility. Emergency Phone Numbers, Exit Plan, and Menu: reviewed. Food Service: the facility will provide catering for clients once clients are accepted. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: inspected. Appliances: microwave and refrigerator inspected. Knives: no knives are stored at the facility. Toxins: no toxins are stored at the facility. Medication: the facility does not handle medications. First-Aid Kit and Activity Supplies: observed and available. Client & Staff Files: this is an initial inspection and LPA observed storage space for client and staff files. Fire clearance was approved by Orange County Fire Authority on 12/21/23. Component III was completed with AP during today’s inspection. AP stated they already have liability insurance. During the inspection, LPA and AP observed the following: the water temperature in the bathroom tested at 127 F degrees. AP stated they will correct the water temperature and notify LPA once it has been corrected.
During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed the item(s) listed above must be completed for the facility to meet Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to AP.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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