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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003060
Report Date: 01/07/2025
Date Signed: 01/07/2025 04:29:22 PM

Document Has Been Signed on 01/07/2025 04:29 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:WEST GLENN MANORFACILITY NUMBER:
306003060
ADMINISTRATOR/
DIRECTOR:
ROSARIO NAZARENOFACILITY TYPE:
740
ADDRESS:7242 WESTMINSTER BLVD.TELEPHONE:
(714) 898-2131
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 98CENSUS: 85DATE:
01/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Rosario Clavio-NazarenoTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On this day Licensing Program Analysts (LPAs) Michael Tea and Fred Arias made an unannounced visit to conduct a required annual visit. LPAs were greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 98 residents, of which 50 may be non-ambulatory. Facility has an approved hospice waiver for 3 residents and the facility currently has 85 residents. Administrator (AD) Rosario Nazareno and Licensee (LE) Brian Nazareno arrived shortly to conduct facility tour. AD Nazareno has a valid certificate that expires on 9/9/2025. AD provided updated liability insurance that expires on 3/19/2025.

LPAs along with LE Nazareno toured the facility at 8:40 AM. LPAs toured the physical plant, checked food service, facility documentation and the first aid kit. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 100.9 degrees F and 112 degrees F in all restrooms. Common areas were clean and clear of hazards. LPAs toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detector system was tested by the fire authority on 11/14/2024. Fire extinguishers were fully charged. LPAs reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 9/28/2024. Outside grounds were toured. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, arts & crafts, and bingo. There is shaded outdoor seating for residents. LPAs observed the emergency food and water supply. LPAs reviewed 8 resident files and 8 staff files. Reviewed resident files contained required documentation including admission agreements, physician reports, resident appraisals, LPAs interviewed 4 residents and 4 staff. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training.
CONTINUED ON LIC 809C DATED 1/7/2025
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WEST GLENN MANOR
FACILITY NUMBER: 306003060
VISIT DATE: 01/07/2025
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Medications are stored in a locked room. LPAs counted medication and confirmed accuracy for 8 residents. P&I funds were commingled for all residents.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Two technical violations were issued and one advisory was issued. This report was discussed with the facility representative and a copy was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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