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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006425
Report Date: 02/05/2024
Date Signed: 02/05/2024 11:45:53 AM

Document Has Been Signed on 02/05/2024 11:45 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:
02/05/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Gayle EhrenbergTIME COMPLETED:
12:00 PM
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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. This is the second pre-licensing inspection. Please see LIC809 dated 01/30/2024.

During the initial 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.

Since the initial pre-licensing inspection, AP corrected the water temperature. During today’s inspection, LPA toured the facility with AP, inspected the bathrooms, and observed the water temperature tested at 116 degrees F. The issue noted during the initial pre-licensing inspection has been addressed.

LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. Component III was completed during the initial pre-licensing inspection. 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: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2024
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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