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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600977
Report Date: 12/17/2024
Date Signed: 12/17/2024 04:14:19 PM

Document Has Been Signed on 12/17/2024 04:14 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:TOWN & COUNTRYFACILITY NUMBER:
300600977
ADMINISTRATOR/
DIRECTOR:
SARA MODUGNOFACILITY TYPE:
741
ADDRESS:555 E. MEMORY LANETELEPHONE:
(714) 547-7581
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY: 328CENSUS: 210DATE:
12/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:45 AM
MET WITH:Lori Wear - Care Coordinator TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On this day Licensing Program Analysts (LPAs) Andrea Mendivil and Fred Arias made an unannounced visit to conduct a required annual visit. LPAs were greeted and granted entry into the facility by Care Coordinator Lori Wear and explained the reason for the visit. Administrator (AD) Sara Modungo arrived during the tour. AD Modungo has a valid certificate that expires on 09/02/2026.

At 8:10am LPAs Mendivil and Arias toured the Independent Living and Assisted Living and Memory Care buildings. Facility has 54 residents in assisted living and 58 residents in memory care during today's visit, with 14 on hospice. Facility has a beauty salon, chapel, activity rooms, movie theater and library as well as multiple dining rooms and a bistro area. LPAs observed both the Assisted Living and Memory Care Unit. Assisted Living resident rooms are single occupancy and had the required elements. Memory Care rooms are single and double occupancy. Memory Care has delayed egress doors and an enclosed outside patio for residents. Facility utilizes the electronic medical record. LPAs observed an ample supply of emergency food and water. Smoke detectors tested operational during today's visit. Sprinklers and smoke detectors are also tested by an outside company and last inspection was on 10/23/2024. LPAs toured the outside grounds and observed multiple shaded outside visitation areas. Residents participate in activities such as exercise, music, and outings in the community. Facility had an emergency fire drill conducted on 11/2024 with a third party. LPAs reviewed 5 Assisted Living Facility residents and 5 Memory Care residents and all files contained the required documents.

Therefore based on observations no deficiencies are being cited today per Title 22. An exit interview was conducted and a copy of this report was provided to Administrator.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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