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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424105
Report Date: 10/22/2021
Date Signed: 10/22/2021 01:48:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:VALENCIA TERRACEFACILITY NUMBER:
336424105
ADMINISTRATOR:DYAN SUMMERELLFACILITY TYPE:
740
ADDRESS:2300 SOUTH MAIN STREETTELEPHONE:
(951) 273-1300
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:84CENSUS: 63DATE:
10/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Edgar Gallardo, Resident Relations DirectorTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Amy Goldenberg is conducting this unannounced visit for the purpose of a health and safety check. LPA met with Edgar Gallardo, Resident Relations Director.

During this visit LPA conducted a tour of the facility. The facility capacity is for 84 residents, currently 63 reside here. LPA tour included the emergency food supply storage, menus, lunch time meal serving, viewing of common areas, hallways and a percentage of resident apartments. LPA assessed the water temperature in five (5) resident apartments, #251, #256, # 264, # 181, #188. Temperature ranged from 105-116 degrees F. LPA spoke with residents in these rooms.

Based on the observations made during this case management visit, there are no immediate risks noted. There are no deficiencies being cited per Title 22, Division 6 of The California Code of Regulations.

This report was reviewed with and a copy was provided to the facility representative.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy GoldenbergTELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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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