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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004750
Report Date: 09/29/2021
Date Signed: 09/29/2021 03:19:47 PM

Document Has Been Signed on 09/29/2021 03:19 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:EASTWOOD CARE HOMEFACILITY NUMBER:
306004750
ADMINISTRATOR:ANNA MALLARIFACILITY TYPE:
740
ADDRESS:8426 CHOPIN DRIVETELEPHONE:
(714) 735-9004
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY: 6CENSUS: 5DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Paulo FaeldoTIME COMPLETED:
12:17 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver Paulo Faeldo and explained the reason for the visit. Administrator Anna Mallari has a current administrator certificate expiring on 12/26/2021.

At 10:35 AM, LPA toured the facility with Caregiver Faeldo. Facility has 5 residents in care during today's visit. LPA observed residents relaxing in the facility. LPA spoke with all residents and all appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms are single and double occupancy and had the required elements as well as restrooms stocked with soap/ sanitizer. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the entrance of the facility. Facility utilizes a visitor sign in sheet. Facility has covid precaution postings as well as all required department postings. LPA observed the first aid kit has all required items. Facility mitigation plan has been approved. LPA observed an ample supply of emergency food and water. LPA toured the outside grounds and observed the shaded outside visitation area. Exit gate is unlocked and self latching. Residents participate in activities such as outings in the community. LPA observed the locked medication storage area. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed five resident files during the visit and all files are up to date including emergency information. All residents and staff are vaccinated for Covid-19.

During the visit, LPA consulted with Caregiver Faeldo regarding the importance of facility staff wearing masks inside the facility.

No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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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