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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004771
Report Date: 06/17/2024
Date Signed: 06/17/2024 09:57:49 AM

Document Has Been Signed on 06/17/2024 09:57 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GOLDEN FLOWER MANOR, LLCFACILITY NUMBER:
306004771
ADMINISTRATOR/
DIRECTOR:		FLORICA GHEORGHEFACILITY TYPE:
740
ADDRESS:2411 E. LA PALMA AVE.TELEPHONE:
(714) 215-4283
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 6CENSUS: 5DATE:
06/17/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Florica GheorgheTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On June 17, 2024, at 8:00am Licensing Program Analyst (LPA) Edward Kim arrived to complete the required 1-year annual visit that was started June 12, 2024. LPA Kim was greeted and granted entry by Administrator (AD) Florica Gheorghe.

During the visit, LPA conducted a full audit of all staff files, resident files, and all resident medications. LPA Kim conducted 2 staff interviews and 2 resident interviews.

No deficiencies cited during this visit.

An exit interview was conducted, and a copy of this report was provided to Administrator Florica Gheorghe..
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
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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