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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005478
Report Date: 11/04/2021
Date Signed: 11/04/2021 03:17:57 PM

Document Has Been Signed on 11/04/2021 03:17 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:SAINT BENEDICT CARE LLCFACILITY NUMBER:
306005478
ADMINISTRATOR:ALMIRANEZ, ULDARICOFACILITY TYPE:
740
ADDRESS:8925 CANARY AVENUETELEPHONE:
(949) 290-6006
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 6CENSUS: 5DATE:
11/04/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Roel Atanacio, Caregiver and Rico Almiranez, Licensee/Administrator via telephoneTIME COMPLETED:
03:33 PM
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Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted a POC visit from a citation that was issued during a Case Management visit conducted on 10/19/2021. LPA Quiroz met with Licensee/Administrator Rico Almiranez via telephone and Caregiver Roel Atanacio and explained reason for today's visit. Based upon this inspection, LPA Quiroz observed the following:

*Deficiency cited under Title 22 Regulation 87468.1(a)(3) Personal Rights of Residents - has been cleared. Licensee complied with the terms of the POC.



An exit interview was conducted with L/AD Almiranez via telephone and Caregiver Roel Atanacio, a copy of this report was provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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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